Epididymitis

Background

-acute scrotal pain is a common reason for ER visit

-epididymitis is entity most often confused with testicular torsion

-sexually active men <35yo: Chlamydia trachomatis, Neisseria gonorrhea

-men engaging in anal intercourse, non sexually active and/or >35, also consider: E. Coli, Pseudomonas, Enterobacteraciaceae, TB, syphilis

Diagnosis

-pain of gradual onset, peak at 24 hours

-cremasteric reflex intact

-pain relieved with elevation of testicle (positive Prehn sign)

-US shows scrotal wall thickening and hyperemia, possible reactive hydrocele or pyocele

-UA may show pyuria but absence does not rule out disease

Work-Up

-UA, Urine culture

-urethral gram stain, culture, chlamydia, gonorrhea

-testicular US

DDx

-testicular torsion

-torsion of testicular appendage

-testicular tumor

-orchitis

-scrotal abscess

-indirect inguinal hernia

Treatment

-scrotal elevation

-analgesia

-antibiotics:

    -sexually transmitted (<35yo):

         - ceftriaxone 250mg IM x1 or cipro 500mg PO x1 for gonorrhea

         - doxycycline 100mg PO BID x 14 days for chlamydia

    -anal intercourse, nonsexually active, instrumentation and/or >35yo:

         - cipro 500mg PO BID x 14 days OR Ofloxacin 200mg PO BID x 14 days

         - IV: piperacillin/taxobactam 3.375g IV q6 or ampicillin/sulbactam 3g IV q6

-treat sexual partner

Disposition

-admit for systemic signs of toxicity (fever, chills, nausea, vomiting)

-discharge home with follow up in one week if non toxic

Source

Adapted from:

Anatomical Approach to Scrotal Emergencies: A New Paradigm for the Diagnosis and Treatment of the Acute Scrotum. The Internet Journal of Urology 2010 : Volume 6 Number 2. Sardar Ali. KhanRosens

Authors: