Acute Epididymorchitis 1

Acute Epididymorchitis
I. Clinical Evaluation of Testicular Pain A. History. Epididymorchitis is indicated by a unilateral painful testicle and a history of unprotected intercourse, new sexual partner, urinary tract infection, dysuria, or discharge. Symptoms may occur following acute lifting or straining. B. C. Physical. The epididymis and testicle are painful, swollen, and tender. The scrotum may be erythematosus and warm with associated spermatic cord thickening or penile discharge. Differential Diagnosis of Painful Scrotal Swelling 1. Epididymitis, testicular torsion, testicular tumor, hernia. 2. Torsion is characterized by sudden onset, age <20, elevated testicle, and previous scrotal pain. The epididymis will be located anteriorly on either side, and there is an absence of evidence of urethritis and UTI. 3. Epididymitis is favored by fever, laboratory evidence of urethritis or cystitis, and increased scrotal warmth. II. A. B. Laboratory Evaluation of Epididymorochitis Epididymorchitis is indicated by leukocytosis with a left shift; UA shows pyuria and bacteriuria. Midstream urine culture will reveal gram negative bacilli. Chlamydia and Neisseria cultures should be taken, although they are often unsuccessful. Epididymal aspirate may be indicated if there is a poor treatment response or recurrent infection. C. Common Pathogens 1. Younger Men. Epididymorchitis is usually associated with sexually transmitted organisms such as Chlamydia, gonorrhea. 2. Older Men. It is usually associated with concomitant urinary tract infection or prostatitis caused by E. coli, proteus, Klebsiella, Enterobacter, or Pseudomonas. III. A. B. Treatment of Epididymorchitis Bed rest during acute phase; scrotal elevation with athletic supporter; ice pack, analgesics, and antipyretics. Sexual and physical activity should be avoided. Sexually Transmitted Epididymitis in Sexually Active Males 1. Ceftriaxone (Rocephin) 250 mg IM x 1 dose AND Doxycycline 100 mg PO bid x 10 days 2. Treat sexual partners OR 3. Ofloxacin (Floxin) 300 mg bid x 10 days. C. D. Epididymitis Secondary to Urinary Tract Infection 1. TMP/SMX DS bid for 10 days or ofloxacin (Floxin) 300 mg PO bid for 10 days. Alternative that will Cover Sexually Transmitted and Urinary Tract Infections 1. Ofloxacin (Floxin) 300 mg po bid for 10 days AND Doxycycline 100 gm PO bid x 10 days. 2. Treat sexual partners.

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