Epididymitis: Difference between revisions
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**Consider chlamydia, gonorrhea | **Consider chlamydia, gonorrhea | ||
*Not sexually active, age >35yo, or anal intercourse: | *Not sexually active, age >35yo, or anal intercourse: | ||
**Also consider E. | **Also consider E. coli, pseudomonas, enterobacter, TB, syphilis | ||
==Diagnosis== | ==Diagnosis== | ||
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==Work-Up== | ==Work-Up== | ||
#UA, | #UA | ||
##Pyuria seen in half of cases | |||
#Ucx (children, elderly men) | |||
#Urine GC/Chlam (urethral discharge or age <40) | |||
#Ultrasound for equivocal cases | #Ultrasound for equivocal cases | ||
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#Analgesia | #Analgesia | ||
#Abx | #Abx | ||
##Sexually transmitted (< | ##Sexually transmitted (<40yo): | ||
###CTX 250mg IM x1 for GC AND: | ###CTX 250mg IM x1 for GC AND: | ||
###Doxycycline 100 mg BID x10d for chlamydia | ###Doxycycline 100 mg BID x10d for chlamydia | ||
##Anal intercourse, nonsexually active, and/or > | ##Anal intercourse, nonsexually active, and/or >40yo: | ||
###PO: Cipro 500mg BID x 14d OR Ofloxacin 200mg BID x 14d | ###PO: Cipro 500mg BID x 14d OR Ofloxacin 200mg BID x 14d | ||
###IV: Piperacillin/taxobactam 3.375g IV q6 or ampicillin/sulbactam 3g IV q6 | ###IV: Piperacillin/taxobactam 3.375g IV q6 or ampicillin/sulbactam 3g IV q6 | ||
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==Disposition== | ==Disposition== | ||
#Admit for | #Admit for: | ||
#D/c w/ f/u in | ##Systemic signs of toxicity (fever, chills, N/V) | ||
#D/c w/ urology f/u in 1wk if non toxic | |||
==See Also== | ==See Also== | ||
Revision as of 20:24, 17 August 2011
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
DDx
- Testicular torsion
- Torsion of testicular appendage
- Testicular tumor
- Orchitis
- Scrotal abscess
- Indirect inguinal hernia
Treatment
- Scrotal elevation
- Analgesia
- Abx
- Sexually transmitted (<40yo):
- CTX 250mg IM x1 for GC AND:
- Doxycycline 100 mg BID x10d for chlamydia
- Anal intercourse, nonsexually active, and/or >40yo:
- PO: Cipro 500mg BID x 14d OR Ofloxacin 200mg BID x 14d
- IV: Piperacillin/taxobactam 3.375g IV q6 or ampicillin/sulbactam 3g IV q6
- Treat sexual partner
- Sexually transmitted (<40yo):
Disposition
- Admit for:
- Systemic signs of toxicity (fever, chills, N/V)
- D/c w/ urology f/u in 1wk if non toxic
See Also
Torsion of Testicular Appendages
Source
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. KhanRosens
CDC Guidelines