URINARY TRACT INFECTION(S)- EPIDIDYMITIS

Question 1

Pertinent anatomy of epididymitis

Answer 1

(a) Testicle
(b) Epididymis
(c) Spermatic cord and vessels
(d) Prostate and ejaculatory duct
(e) Urethra

Question 2

inflammation and/or infection of the Epididymis**

Answer 2

Epididymitis

Question 3

Most cases are infectious and can be divided into one of two categories**

Answer 3

1) Sexually transmitted forms

2) Non-sexually transmitted forms

Question 4

details of Sexually transmitted forms

Answer 4

a) Typically occur in men under 40 years
b) Associated with urethritis
c) Result from Chlamydia trachomatis or Neisseria gonorrhoeae**

Question 5

details of Non-Sexually transmitted forms

Answer 5

a) Typically occur in older men
b) Associated with urinary tract infections and prostatitis
c) Caused by gram-negative rods (E-coli, Klebsiella)

Question 6

Route of infection

Answer 6

probably via the urethra to the ejaculatory duct

Question 7

Signs and symptoms

Answer 7

(a) May follow acute physical strain (heavy lifting), trauma, or sexual activity.**
(b) Associated symptoms of
1) Urethritis
2) Cystitis
(c) Pain develops in the scrotum and may radiate along the spermatic cord or to the flank.
(d) Fever
(e) Scrotal swelling is usually apparent.
(f) Early in the course
1) the epididymis may be distinguishable from the testis
(g) Later
1) The two may appear as one enlarged, tender mass
(h) The prostate may be tender on rectal examination.
(i) Prehn sign (elevation of the scrotum above the pubic symphysis improves pain from epididymitis) may be helpful but is not reliable.

Question 8

Differential Diagnosis

Answer 8

(a) Testicular tumor
(b) Testicular torsion
(c) Acute hydrocele
(d) Inguinal hernia

Question 9

Laboratory orders

Answer 9

(a) Complete blood count
(b) Suspected sexually transmitted disease
(c) Non-sexually transmitted variety
1) Urinaysis

Question 10

Laboratory Findings

Answer 10

(a) Complete blood count
1) Leukocytosis and left shift
(b) Suspected sexually transmitted disease
1) Chlamydia trachomatis and Neisseria gonorrhoeae NAAT (nucleic acid amplification testing) on urine
(c) Non-sexually transmitted variety
1) Urinaysis
a) Pyuria
b) Bacteriuria
c) Varying degrees of hematuria

Question 11

Imaging

Answer 11

Scrotal ultrasound

Question 12

Treatment

Answer 12

(a) Antimicrobial therapy
1) Sexually Transmitted
a) Ceftriaxone (Rocephin) PLUS Doxycycline

2) Non-Sexually transmitted
a) Trimethoprim/sulfamethoxazole (Bactrim)
b) Ciprofloxacin (Cipro)
c) Levofloxacin (Levaquin)

(b) Symptomatic relief
1) Bed rest
2) Scrotal support
3) Ice packs
4) Anti-inflammatory analgesics
a) NSAIDS

Question 13

Complications

Answer 13

(a) Delayed or inadequate treatment may result in
1) Epididymo-orchitis
2) Decreased fertility
3) Abscess formation

Question 14

(9) Follow up

(a) Refer to Urology

Answer 14

1) Persistent symptoms and infection despite antibiotic therapy
2) Signs of sepsis or abscess formation