Epididymitis Flashcards
What causes epididymitis?
- 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
Clinical Presentation of Epididymitis
- unilateral pain and swelling of scrotum
- fever
- urethral discharge
- signs and sxs of UTI or prostatitis can also be present
Diagnosis of Epididymitis
- culture voided urethral and midstream specimens
- tailor abx therapy to specific organisms
Epididymitis Pathogens in Pts < 35 Years
- N. gonorrhoeae
- C. trachomatis
- sometimes Enterobacter
Tx of Epididymitis in Pts < 35 (gonorrhea, c. trachomatis)
- ceftriaxone 250 mg IM x1 PLUS
- doxycycline 100 mg po bid x10 days
Non-Pharm Tx for Epididymitis in Pts <35
- bedrest
- scrotal elevation
- analgesics
- treat partners
- test for HIV and syphilis
Epididymitis Pathogens in Men >35 or MSM
Enterobacteriaceae
Tx of Epididymitis in Men >35 or MSM
-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
Supportive Care for Epididymitis
- 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
What is expedited partner therapy?
-partners of pts who test positive for chlamydia or gonorrhea are provided medications w/o prior medical evaluation
In addition to the medication, what should be provided with expedited partner therapy?
- treatment instructions
- warnings about taking the meds (if pregnant or allergies)
- general STI health education/counseling
- statement advising that partner seek personal medical evaluation
Pros of Patient Delivered Partner Therapy
- promising option for controlling STI occurrence
- ANA recognized benefits and recommends PDPT when tx of partners can’t be accomplished by other means
Cons of PDPT
- 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