Epididymitis Flashcards
1
Q
Symptoms
A
Unilateral testicular pain + swelling
Tenderness swelling
↑temp of epididymis and vas deferens
Prehn’ sign: pain relief with elevation of testes
a/w
Fever
+/- urethritis + discharge
LUTS
2
Q
Risk Factors
A
- Age <35 y/o a/w Gon + Chl
- Age >35 y/o a/w Pseudomonas, E.Coli, HiB
- PMHx: UTI, Instrumentation / Catheterization, Reflux….?
- Sexual Hx: Unprotected Sex
- Social Hx: Strenuous Exercise, prolonged sitting
3
Q
DDX
A
- Trauma
- Torsion – high riding, transverse testicle, pain w/ testicular elevation, usually < 35 yo
- Tumor
- Mumps, TB, Chl + Gon (<35 y/o), Pseudomonas, E. Coli, HiB (>35 y/o)
4
Q
Physical Exam + specific maneuvers
A
Genitalia: • Overlying erythema, swelling • Palpation of testes • Inguinal LAD • Cremasteric Reflex • Prehn’s Sign
5
Q
Investigations
A
- U/A
- First void stream for Gn + Chl NAAT
- Urethral Swab for Gn clx if Gn likely
- Midstream Urine Clx (E. Coli, Pseudomonas, HiB)
- Urgent testicular U/S if r/o torsion
6
Q
First Line and 2nd line antibiotics
A
>35y/o: • Ciprofloxacin • Levofloxacin <35y/o or multiple sex partners: • Ceftriaxone OR Cefixime x1 ***PLUS*** First Line: • Azithromycin • Doxycycline Second Line: • Ciprofloxacin • Levofloxacin ***ANY OF THE SECOND LINE PLUS*** • Azithromycin • Doxycycline
7
Q
When and why to follow up
A
3-7 days
8
Q
What additional tests if positive for GN / CL
A
• STI testing (HIV / VDRL) if results are positive for GN + Chl
9
Q
Report
A
- Partner + public health for reportable diseases
* Enterobacteriaceae may require investigations for lower urinary tract abnormalities
10
Q
Complications
A
- Testicular atrophy
* 30% - persistent infertility
