Epididymitis

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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: