Renal & Urology/ Epididymitis

Question 1

What are the signs and symptoms of acute bacterial epididymitis?

Answer 1

• Dysuria
• frequency
• urgency
• testicular pain
• fever

Question 2

What are the causative organisms in infectious epididymitis in males below 35 years of age?

Answer 2

• Chlamydia trachomatis (most common)
• Neisseria gonorrhoeae

Question 3

What are the causative organisms in infectious epididymitis in males over 35 years of age?

Answer 3

• Escherichia coli
• Pseudomonas
• sexually transmitted organisms are possible, but less common

Question 4

What is the pathogenesis of noninfectious epididymitis?

Answer 4

• Urine refluxes through the ejaculatory ducts and vas deferens into the epididymis resulting in chemical inflammation

Question 5

What are the risk factors for noninfectious epididymitis?

Answer 5

• Prolonged sitting
• vigorous exercise (heavy lifting)

Question 6

What is Prehn sign?

Answer 6

• Decreased pain with scrotal elevation, suggesting the patient has epididymitis rather than testicular torsion

Question 7

Is Prehn sign a reliable way of diagnosing epididymitis?

Answer 7

No. It also does not reliably exclude testicular torsion.

Question 8

What are the treatments for infectious epididymitis?

Answer 8

• Ice
• scrotal elevation/support
• NSAIDs
• if <35 years
  
  • ceftriaxone 250 mg IM × 1 day and doxycycline 100 mg PO BID × 10 days
• if >35 years
  
  • ofloxacin 300 mg PO BID × 10 days or levofloxacin 500 mg PO QD × 10 days