Epididymitis:

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Intro: it is the inflammation of epididymis (the tube posterior to the testicle that carries and stores sperms).

Clinical presentation: can occur alone or along with orchitis (inflammation of testes). It could be acute (<6weeks) or chronic (>3months). Usually starts as

  • gradual onset of unilateral scrotal pain,
  • discomfort
  • tenderness
  • swelling
  • fever
  • dysuria
  • hematuria
  • epididymitis symptoms can mimic other conditions of malignancy or testicular torsion; so need to exclude other possible diagnosis.

 Etiology:

Risk factors Bacterial pathogens
Sex Chlamydia trachomatis
UT instrumentation N.gonorrhea
Obstructive anatomical abnormalities E.coli
tumors  
autoimmunity  
amiodarone  
Strenuous physical activity  
Bicycle riding, prolonged sitting  

 Diagnosis: is carried out thorough physical examination, lab testing (CBC, CUE, and urethral culture) is required. NAAT (nucleic acid amplification test) is done when C.trachomatis and N.gonorrhea are suspected, in sexually active men of <35 years.

Treatment:

Condition Therapy
Bacterial  

Antibiotics

 

Nonbacterial inflammation  

Symptomatic release… bed rest, cold compress, anti-inflammatory drugs, scrotum elevation, analgesics.

 

Amiodarone induced Chronic epididymitis Discontinuation or decrease dose of amiodarone
Antibiotics, anti-inflammatory drugs, anxiolytics, narcotic analgesic, epididymectomy

 

 

 

Suspected pathogens Risk factors T/M
N. gonorrhea

C.trachomatis

<35 years of age

Sexually active

Ceftriaxone 250mg IM single dose

PLUS

Doxycycline 100mg po bid x 10 days

Enteric organisms (E.coli)  

          >35 years

UT instrumentation, Benign prostate hyperplasia

Levofloxacin 500mg po daily x 10 days

OR

Ofloxacin 300mg po bid x 10 days

 

N. gonorrhea

C.trachomatis

e.coli

 

Sexual intercourse

 

Ceftriaxone 250mg IM single dose

Plus

Levofloxacin 500mg po daily x 10 days

Or

Ofloxacin 300mg po bid x 10 days

 

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