EPIDIDYMITIS

Question 1

DDX

Answer 1

Trauma
Testicular Torsion
Testicular (or epididymal) appendage torsion

Acute Epididymitis
Orchitis
Appendicitis

Incarcerated inguinal hernia
Varicocele

Question 2

Etiology

Answer 2

Age <35 y/o or sexually active a/w Gon + Chl
Age < 35 a/w E. Coli

Question 3

Clinical Features

Answer 3

Gradual onset Unilateral testicular pain + swelling
or
Abdominal Pain

a/w
Fever
+/- urethritis + discharge
LUTS

Swollen tender epididymis or teste in normal anatomical position
↑temp of epididymis and vas deferens

Question 4

Risk Factors

Answer 4

PMHx: UTI, Instrumentation / Catheterization, Reflux….?
Sexual Hx: Unprotected Sex
Social Hx: Strenuous Exercise, prolonged sitting

Question 5

Physical Exam

Answer 5

Ipsilateral Cremasteric Reflex in tact
Prehn’ sign: pain relief with elevation of testes

Question 6

Investigations

Answer 6

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 equivocal r/o torsion

Question 7

Management: Suspected STI

Answer 7

Ceftriaxone 250 mg IM x 1
OR
Cefixime 800 mg PO x1

AND

Doxycycline 100 mg PO bid x 14 days

Bed Rest
Scrotal Support
Analgesics
Sitz Baths
Ice Packs

Question 8

Management: No STI Suspected

Answer 8

Ciprofloxacin 500 mg PO bid x 14 days
OR
TMP/SMX 1 DS tab PO bid x 14 days

Bed Rest
Scrotal Support
Analgesics
Sitz Baths
Ice Packs