Epididymitis
Presentation :
- Unilateral pain localizing to the posterior and superior aspects of the testicle
- Pain onset is typically subacute
- May be accompanied by dysuria, pyuria, and fever
- Scrotum may be edematous and erythematous.
- Pain may decrease with testicular elevation (unlike Testicular Torsion)
Pathophysiology :
- Usually secondary to infection
- When infection spreads to the adjacent testis, it is termed epididymo-orchitis
Diagnostic Testing:
- Urinalysis and culture should be obtained in all patients, STI testing when suspicion is high
- Ultrasonography (often to r/o torsion) demonstrates normal or increased blood flow to the testicle and epididymis.
- Imaging is not usually necessary to confirm the dx
Treatment :
- If <35y OR high risk for STI: IM ceftriaxone and PO doxycycline (covg for gonorrhea and chlamydial infection)
- If >35y AND low risk for STI: PO levofloxacin (enteric covg; colonic bacteria like E. Coli most common)
- All men engaging in insertive anal intercourse: IM ceftriaxone and PO levofloxacin (enteric + STI covg)
Prognosis:
References:
Created on: Tuesday 08-15-2023