We need you! Join our contributor community and become a WikEM editor through our open and transparent promotion process.
Epididymitis
From WikEM
(Redirected from Epididymorchitis)
Contents
Background
- Often confused with testicular torsion
- Cremasteric reflex intact in epididymitis
- Sexually active men <35yo:
- Not sexually active, age >35yo, or anal intercourse:
- Also consider E. coli, pseudomonas, enterobacter, TB, syphilis
- Chemical epididymitis
- Consider in the patient with afib and testicular pain
- Testicular pain and swelling in patients on amiodarone
Clinical Features
- Pain of gradual onset, peaks at 24hr
- Dysuria
- Urinary frequency
- Fever
- Pain relieved with elevation of testicle (Prehn sign)
- Sensitivity: 91.3%, specificity: 78.3. Does not rule out testicular torsion
Differential Diagnosis
Testicular Diagnoses
- Testicular torsion
- Epididymitis
- Orchitis
- Torsion of testicular appendage
- Scrotal abscess
- Fournier gangrene
- Hydrocele
- Indirect inguinal hernia
- Hematocele
- Spermatocele
- Testicular trauma
- Testicular rupture
- Varicocele
- Inguinal lymph node (Lymphadenitis)
- Testicular tumor
- Cellulitis
- Tinea cruris
Evaluation
- Urinalysis
- Pyuria seen in half of cases
- Urine culture (children, elderly men)
- Urine GC/Chlam (urethral discharge or age <40)
- Ultrasound for equivocal cases
- Older men should be evaluated for urinary retention
Management
- Scrotal elevation
- Analgesia
Antibiotics
- For acute epididymitis likely caused by STI
- Ceftriaxone 250 mg IM in a single dose PLUS
- Doxycycline 100 mg orally twice a day for 10 days
- For acute epididymitis most likely caused by STI and enteric organisms (MSM)
- Ceftriaxone 250 mg IM in a single dose PLUS
- Levofloxacin 500 mg orally once a day for 10 days OR
- Ofloxacin 300 mg orally twice a day for 10 days
- For acute epididymitis most likely caused by enteric organisms
- Levofloxacin 500 mg orally once daily for 10 days OR
- Ofloxacin 300 mg orally twice a day for 10 days
Treat sexual partner if possible
- If med adherence is an issue:
- Ceftriaxone 250mg IM once
- PLUS azithromycin 1 g PO once
Pediatric Epididymitis[1]
- Rule out testicular torsion
- Bed rest to ensure lymphatic drainage
- Ice packs, acetaminophen, ibuprofen
- Rarely oral narcotics
- Pediatric urology follow up outpatient in non-toxic child for possible GU anatomical abnormalities
- Antibiotics for 10-14 days, with urine culture sent:
- Trimethroprim-sulfamethoxazole
- Amoxicillin-clavulanate
- Coverage for chlamydia and N. gonorrhoeae in suspected cases of sexual transmission
- Avoid fluoroquinolones in pediatric patients
- Severely ill or septic children:
- At least, first generation cephalosporin
- PLUS aminoglycoside
Disposition
- Admit for:
- Systemic signs of toxicity (fever, chills, nausea/vomiting)
- Discharge with urology follow-up in 1 week if non-toxic
See Also
References
- ↑ Richman MN and Bukowski TP. Pediatric Epididymitis: Pathophysiology, Diagnosis, and Management. Infect Urol. 2001;14(2).
