Epididymitis: Difference between revisions
| Line 29: | Line 29: | ||
#[[Antibiotics]] | #[[Antibiotics]] | ||
##Sexually transmitted (<40yo): | ##Sexually transmitted (<40yo): | ||
###[[Ceftriaxone]] 250mg IM x1 for [[GC]] AND | ###[[Ceftriaxone]] 250mg IM x1 for [[GC]], AND | ||
###[[Doxycycline]] 100 mg BID x10d for [[chlamydia]] | ###[[Doxycycline]] 100 mg BID x10d for [[chlamydia]] | ||
##Men > 40yrs old, History of anal intercourse or non-sexually active: | ##Men > 40yrs old, History of anal intercourse or non-sexually active: | ||
Revision as of 04:34, 21 March 2014
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
- Note that testicular tumors are frequently misdiagnosed as epididymitis
DDx
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
Treatment
- Scrotal elevation
- Analgesia
- Antibiotics
- Sexually transmitted (<40yo):
- Ceftriaxone 250mg IM x1 for GC, AND
- Doxycycline 100 mg BID x10d for chlamydia
- Men > 40yrs old, History of anal intercourse or non-sexually active:
- PO: Ciprofloxacin 500mg BID x 14d OR ofloxacin 200mg BID x 14d
- IV: Piperacillin/Tazobactam 3.375g IV q6 or Ampicillin/Sulbactam 3g IV q6
- Sexually transmitted (<40yo):
Treat sexual partner if possible
Disposition
- Admit for:
- Systemic signs of toxicity (fever, chills, N/V)
- D/c w/ urology f/u in 1wk if non toxic
See Also
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. Khan
CDC Guidelines http://www.cdc.gov/std/treatment/2010/epididymitis.htm