Epidydimitis

Question 1

Define

Answer 1

Inflammation of the epididymis causing pain and swelling, which is usually unilateral and develops over the course of a few days.

Question 2

Cause in sexually active men

Answer 2

In sexually active men, epididymitis is most commonly caused by sexually transmitted organisms including Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium.

Question 3

Cause in older men

Answer 3

In older men, the causative organisms are often enteric pathogens, and epididymitis may be associated with bladder outlet obstruction, recent instrumentation of the urinary tract, or systemic illness.

Question 4

Diagnosis

Answer 4

Diagnostic tests include a Gram stain of urethral secretions, and urine specimens for nucleic acid amplification tests for C trachomatis, N gonorrhoeae, and M genitalium (where available). Urine microscopy and culture is also indicated if urinary pathogens are suspected.

Question 5

Treatment

Answer 5

Treatment relies on supportive measures, including bed rest, scrotal elevation, and analgesics, in conjunction with empirical antibiotic therapy based on the patient’s age, and clinical and sexual history.