Epididymitis: Difference between revisions
No edit summary |
|||
| Line 7: | Line 7: | ||
**Also consider E. coli, pseudomonas, enterobacter, TB, syphilis | **Also consider E. coli, pseudomonas, enterobacter, TB, syphilis | ||
== | ==Clinical Features== | ||
*Pain of gradual onset, peaks at 24hr | *Pain of gradual onset, peaks at 24hr | ||
**Dysuria, frequency, fever | **Dysuria, frequency, fever | ||
*Pain relieved with elevation of testicle (positive Prehn sign) | *Pain relieved with elevation of testicle (positive Prehn sign) | ||
== | ==Differential Diagnosis== | ||
{{Template:Testicular DDX}} | |||
==Diagnosis== | |||
*UA | *UA | ||
**Pyuria seen in half of cases | **Pyuria seen in half of cases | ||
| Line 19: | Line 22: | ||
*Ultrasound for equivocal cases | *Ultrasound for equivocal cases | ||
*Older men should be evaluated for urinary retention | *Older men should be evaluated for urinary retention | ||
==Treatment== | ==Treatment== | ||
| Line 39: | Line 39: | ||
*[[Traumatic Epididymitis]] | *[[Traumatic Epididymitis]] | ||
== | ==References== | ||
*Anatomical Approach to Scrotal Emergencies: A New Paradigm for the Diagnosis and Treatment of the Acute Scrotum. The Internet Journal of Urology 2010 : Volume 6 Number 2. Sardar Ali. Khan | *Anatomical Approach to Scrotal Emergencies: A New Paradigm for the Diagnosis and Treatment of the Acute Scrotum. The Internet Journal of Urology 2010 : Volume 6 Number 2. Sardar Ali. Khan | ||
*CDC Guidelines http://www.cdc.gov/std/treatment/2010/epididymitis.htm | *CDC Guidelines http://www.cdc.gov/std/treatment/2010/epididymitis.htm | ||
Revision as of 11:36, 20 July 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
Clinical Features
- Pain of gradual onset, peaks at 24hr
- Dysuria, frequency, fever
- Pain relieved with elevation of testicle (positive Prehn sign)
Differential Diagnosis
Testicular Diagnoses
- Scrotal cellulitis
- Epididymitis
- Fournier gangrene
- Hematocele
- Hydrocele
- Indirect inguinal hernia
- Inguinal lymph node (Lymphadenitis)
- Orchitis
- Scrotal abscess
- Spermatocele
- Tinea cruris
- Testicular rupture
- Testicular torsion
- Testicular trauma
- Testicular tumor
- Torsion of testicular appendage
- Varicocele
- Pyocele
- Testicular malignancy
- Scrotal wall hematoma
Diagnosis
- 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
Treatment
- Scrotal elevation
- Analgesia
Antibiotics
- For acute epididymitis likely caused by STI [1]
- Ceftriaxone 500 mg IM in a single dose PLUS
- Doxycycline 100 mg orally twice a day for 10 days
- For acute epididymitis most likely caused by STI and enteric organisms (MSM)
- Ceftriaxone 500 mg IM in a single dose PLUS
- Levofloxacin 500 mg orally once a day for 10 days
- For acute epididymitis most likely caused by enteric organisms
- Levofloxacin 500 mg orally once daily for 10 days
For persons weighing ≥150 kg, 1 g of ceftriaxone should be administered.
Disposition
- Admit for:
- Systemic signs of toxicity (fever, chills, N/V)
- Discharge with urology follow-up in 1 week if non-toxic
See Also
References
- Anatomical Approach to Scrotal Emergencies: A New Paradigm for the Diagnosis and Treatment of the Acute Scrotum. The Internet Journal of Urology 2010 : Volume 6 Number 2. Sardar Ali. Khan
- CDC Guidelines http://www.cdc.gov/std/treatment/2010/epididymitis.htm