Epididymitis

Question 1

What causes epididymitis?

Answer 1

• can be trauma, but usually 2/2 infx
• potential complication of STD
• non-sexually transmitted infectious epididymitis mainly in middle aged or older men and caused by coliform bacteria or Pseudomonas

Question 2

Clinical Presentation of Epididymitis

Answer 2

• unilateral pain and swelling of scrotum
• fever
• urethral discharge
• signs and sxs of UTI or prostatitis can also be present

Question 3

Diagnosis of Epididymitis

Answer 3

• culture voided urethral and midstream specimens

- tailor abx therapy to specific organisms

Question 4

Epididymitis Pathogens in Pts < 35 Years

Answer 4

• N. gonorrhoeae
• C. trachomatis
• sometimes Enterobacter

Question 5

Tx of Epididymitis in Pts < 35 (gonorrhea, c. trachomatis)

Answer 5

• ceftriaxone 250 mg IM x1 PLUS

- doxycycline 100 mg po bid x10 days

Question 6

Non-Pharm Tx for Epididymitis in Pts <35

Answer 6

• bedrest
• scrotal elevation
• analgesics
• treat partners
• test for HIV and syphilis

Question 7

Epididymitis Pathogens in Men >35 or MSM

Answer 7

Enterobacteriaceae

Question 8

Tx of Epididymitis in Men >35 or MSM

Answer 8

-levofloxacin 500-750 mg IV/po qd OR
-cipro 500 mg po bid or 400 mg IV bid
x10-14 days

-alt: amp/sulbactam, ticarcillin/clav, pip/tazo, cefotaxime, ceftriaxone

Question 9

Supportive Care for Epididymitis

Answer 9

• analgesics PRN
• rest in bed with legs slightly apart
• rest testes on towel roll
• scrotal support when sitting, standing, walking
• wear non-constrictive, lightweight clothing until swelling subsides

Question 10

What is expedited partner therapy?

Answer 10

-partners of pts who test positive for chlamydia or gonorrhea are provided medications w/o prior medical evaluation

Question 11

In addition to the medication, what should be provided with expedited partner therapy?

Answer 11

• treatment instructions
• warnings about taking the meds (if pregnant or allergies)
• general STI health education/counseling
• statement advising that partner seek personal medical evaluation

Question 12

Pros of Patient Delivered Partner Therapy

Answer 12

• promising option for controlling STI occurrence

- ANA recognized benefits and recommends PDPT when tx of partners can’t be accomplished by other means

Question 13

Cons of PDPT

Answer 13

• potential liability in providing tx for unseen pts
• does not allow screening partner for other STIs, HIV, pregnancy
• legality of PDPT not clear in many states