Epididymitis: Difference between revisions
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==Differential Diagnosis==
==Differential Diagnosis==
*Testicular tumors
{{Template:Testicular DDX}}
{{Template:Testicular DDX}}


Revision as of 15:41, 22 February 2015

Background

  • Often confused with testicular torsion
    • Cremasteric reflex intact
  • Sexually active men <35yo:
    • Consider chlamydia, gonorrhea
  • Not sexually active, age >35yo, or anal intercourse:
    • Also consider E. coli, pseudomonas, enterobacter, TB, syphilis

Diagnosis

  • Pain of gradual onset, peaks at 24hr
    • Dysuria, frequency, fever
  • Pain relieved with elevation of testicle (positive Prehn sign)

Work-Up

  • UA
    • Pyuria seen in half of cases
  • Ucx (children, elderly men)
  • Urine GC/Chlam (urethral discharge or age <40)
  • Ultrasound for equivocal cases
  • Older men should be evaluated for urinary retention

Differential Diagnosis

  • Testicular tumors

Testicular Diagnoses

Treatment

  1. Scrotal elevation
  2. Analgesia
  3. Antibiotics
    1. Sexually transmitted (<40yo):
      1. Ceftriaxone 250mg IM x1 for GC, AND
      2. Doxycycline 100 mg BID x10d for chlamydia
    2. Men > 40yrs old, History of anal intercourse or non-sexually active:
      1. PO: Ciprofloxacin 500mg BID x 14d OR ofloxacin 200mg BID x 14d
      2. IV: Piperacillin/Tazobactam 3.375g IV q6 or Ampicillin/Sulbactam 3g IV q6

Treat sexual partner if possible

Disposition

  • Admit for:
    • Systemic signs of toxicity (fever, chills, N/V)
  • Discharge with urology follow-up in 1 week if non-toxic

See Also

Source

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