Epididymitis - Revision history

Patricklin at 18:03, 15 June 2024

2024-06-15T18:03:15Z

← Older revision		Revision as of 18:03, 15 June 2024
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	[[File:Gray1144.png\|thumb\|Scrotal anatomy]]		[[File:Gray1144.png\|thumb\|Scrotal anatomy]]
	[[File:Epididymis-KDS.jpg\|thumb\|Adult testicle with epididymis (left is posterior): A. Head of epididymis, B. Body of epididymis, C. Tail of epididymis, and D. Vas deferens.]]		[[File:Epididymis-KDS.jpg\|thumb\|Adult testicle with epididymis (left is posterior): A. Head of epididymis, B. Body of epididymis, C. Tail of epididymis, and D. Vas deferens.]]
			*Inflammation/infection of the epididymis; due to retrograde ascent of pathogens (usually bacterial), the type of which is associated with age
			**Sexually active men <35yo → consider STI organisms including [[Chlamydia\|chlamydia]], [[Gonorrhea\|gonorrhea]]
			**Not sexually active, age >35yo, or anal intercourse → consider [[E. coli]], [[pseudomonas]], [[enterobacter]], [[TB]], [[Syphilis\|syphilis]]
			*Progression of epididymitis results in epididymo-orchitis, now involving testes; isolated bacterial orchitis is rare
	*Often confused with [[testicular torsion]]		*Often confused with [[testicular torsion]]
	**Cremasteric reflex intact in epididymitis		**Cremasteric reflex intact in epididymitis, usually absent in torsion
	*~~Sexually active men <35yo → consider [[Chlamydia\|chlamydia]], [[Gonorrhea\|gonorrhea]]~~		**Epidididymitis typically more gradual onset and has concurrent lower urinary tract complaints
	*~~Not sexually active, age >35yo, or anal intercourse → also consider [[E. coli]], [[pseudomonas]], [[enterobacter]], [[TB]], [[Syphilis\|syphilis]]~~		**Torsion rarer with older men
	*Chemical epididymitis		*Chemical epididymitis
	**Consider in the patient with [[afib]] and testicular pain		**Consider in the patient with [[afib]] and testicular pain
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	==Clinical Features==		==Clinical Features==
	*Pain of gradual onset, peaks at 24hr		*Pain of gradual onset, peaks at 24hr
	*[[Dysuria]]		**Can radiate to inguinal and lower abdominal areas
	*Urinary frequency		*[[Dysuria]] or urinary frequency/urgency
	*[[Fever]]		*[[Fever]]
	*Pain relieved with elevation of testicle ~~(Prehn sign)~~		*Tenderness of epididymis and/or scrotum, overlying erythema or induration
			*Positive Prehn sign: Pain relieved with elevation of testicle
	**Sensitivity: 91.3%, specificity: 78.3. Does not rule out testicular torsion		**Sensitivity: 91.3%, specificity: 78.3. Does not rule out testicular torsion

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	==Disposition==		==Disposition==
	*Admit for systemic signs (fever, chills, nausea/vomiting) or toxic appearance		*Admit for systemic signs (fever, chills, nausea/vomiting), septic or toxic appearance, epididymal or testicular abscess formation, failure of outpt ABX
	*Discharge with urology follow-up in 1 week if non-toxic		*Discharge with urology follow-up in 1 week if non-toxic

Zbuchwald: /* Antibiotics */

2022-12-09T13:33:01Z

Antibiotics

← Older revision		Revision as of 13:33, 9 December 2022
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	===[[Antibiotics]]===		===[[Antibiotics]]===
	{{Epididymitis antibiotics}}		{{Epididymitis antibiotics}}
	*If med adherence is an issue <ref>CDC 2022 guidelines</ref>:
			*If med adherence is an issue <ref>CDC 2022 guidelines</ref>
	**[[Ceftriaxone]] 500mg IM once '''AND'''		**[[Ceftriaxone]] 500mg IM once '''AND'''
	**Azithromycin 1 g PO once		**Azithromycin 1 g PO once

Zbuchwald: /* Management */

2022-12-09T12:32:05Z

Management

← Older revision		Revision as of 12:32, 9 December 2022
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	===[[Antibiotics]]===		===[[Antibiotics]]===
	{{Epididymitis antibiotics}}		{{Epididymitis antibiotics}}
	*If med adherence is an issue<ref>CDC 2022 guidelines</ref>:		*If med adherence is an issue <ref>CDC 2022 guidelines</ref>:
	**[[Ceftriaxone]] 500mg IM once '''AND'''		**[[Ceftriaxone]] 500mg IM once '''AND'''
	**Azithromycin 1 g PO once		**Azithromycin 1 g PO once

Rossdonaldson1: /* Antibiotics */

2022-04-12T16:05:36Z

Antibiotics

← Older revision		Revision as of 16:05, 12 April 2022
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	===[[Antibiotics]]===		===[[Antibiotics]]===
	{{Epididymitis antibiotics}}		{{Epididymitis antibiotics}}
	*If med adherence is an issue:		*If med adherence is an issue<ref>CDC 2022 guidelines</ref>:
	**[[Ceftriaxone]] 500mg IM once '''AND'''		**[[Ceftriaxone]] 500mg IM once '''AND'''
	**Azithromycin 1 g PO once		**Azithromycin 1 g PO once

Chrisurso2: Change Ceftriaxone from 250mg to 500 mg per CDC 2022 guidelines

2022-03-29T20:07:20Z

Change Ceftriaxone from 250mg to 500 mg per CDC 2022 guidelines

← Older revision		Revision as of 20:07, 29 March 2022
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	{{Epididymitis antibiotics}}		{{Epididymitis antibiotics}}
	*If med adherence is an issue:		*If med adherence is an issue:
	**[[Ceftriaxone]] ~~250mg~~ IM once '''AND'''		**[[Ceftriaxone]] 500mg IM once '''AND'''
	**Azithromycin 1 g PO once		**Azithromycin 1 g PO once

Elcatracho: /* Background */

2021-02-21T17:41:17Z

Background

← Older revision		Revision as of 17:41, 21 February 2021
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	[[File:Gray1144.png\|thumb\|Scrotal anatomy]]		[[File:Gray1144.png\|thumb\|Scrotal anatomy]]
	[[File:Epididymis-KDS.jpg\|thumb\|Adult testicle with epididymis (left is posterior): A. Head of epididymis, B. Body of epididymis, C. Tail of epididymis, and D. Vas deferens.]]		[[File:Epididymis-KDS.jpg\|thumb\|Adult testicle with epididymis (left is posterior): A. Head of epididymis, B. Body of epididymis, C. Tail of epididymis, and D. Vas deferens.]]
	*Often confused with testicular torsion		*Often confused with [[testicular torsion]]
	**Cremasteric reflex intact in epididymitis		**Cremasteric reflex intact in epididymitis
	*Sexually active men <35yo → consider [[Chlamydia\|chlamydia]], [[Gonorrhea\|gonorrhea]]		*Sexually active men <35yo → consider [[Chlamydia\|chlamydia]], [[Gonorrhea\|gonorrhea]]
	*Not sexually active, age >35yo, or anal intercourse → also consider E. coli, pseudomonas, enterobacter, TB, [[Syphilis\|syphilis]]		*Not sexually active, age >35yo, or anal intercourse → also consider [[E. coli]], [[pseudomonas]], [[enterobacter]], [[TB]], [[Syphilis\|syphilis]]
	*Chemical epididymitis		*Chemical epididymitis
	**Consider in the patient with afib and testicular pain		**Consider in the patient with [[afib]] and testicular pain
	**Testicular pain and swelling in patients on [[Amiodarone\|amiodarone]]		**Testicular pain and swelling in patients on [[Amiodarone\|amiodarone]]

Rossdonaldson1: /* Evaluation */

2020-11-11T22:49:15Z

Evaluation

← Older revision		Revision as of 22:49, 11 November 2020
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	==Evaluation==		==Evaluation==
	===Workup===		===Workup===
			[[File:Ultrasonography of epididymitis.jpg\|thumb\|Doppler ultrasound of epididymitis, seen as a substantial increase in blood flow in the left epididymis (top image), while it is normal in the right (bottom image). The thickness of the epididymis (between yellow crosses) is only slightly increased.]]
	[[File:PMC5028337 13244 2016 503 Fig17 HTML.png\|thumb\|Acute epididymo-orchitis. Contrast-enhanced CT (a, b) shows thickened and engorged left spermatic cord, with inhomogeneous vascularisation of the ipsilateral epididymis (thin arrows) and testis (arrows). Ultrasound (c) reveals hypervascularisation of the epididymis (+).]]		[[File:PMC5028337 13244 2016 503 Fig17 HTML.png\|thumb\|Acute epididymo-orchitis. Contrast-enhanced CT (a, b) shows thickened and engorged left spermatic cord, with inhomogeneous vascularisation of the ipsilateral epididymis (thin arrows) and testis (arrows). Ultrasound (c) reveals hypervascularisation of the epididymis (+).]]
	*[[Urinalysis]]		*[[Urinalysis]]

Rossdonaldson1: /* Background */

2020-06-04T20:11:03Z

Background

← Older revision		Revision as of 20:11, 4 June 2020
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	==Background==		==Background==
			[[File:Gray1144.png\|thumb\|Scrotal anatomy]]
	[[File:Epididymis-KDS.jpg\|thumb\|Adult testicle with epididymis (left is posterior): A. Head of epididymis, B. Body of epididymis, C. Tail of epididymis, and D. Vas deferens.]]		[[File:Epididymis-KDS.jpg\|thumb\|Adult testicle with epididymis (left is posterior): A. Head of epididymis, B. Body of epididymis, C. Tail of epididymis, and D. Vas deferens.]]
	*Often confused with testicular torsion		*Often confused with testicular torsion

Rossdonaldson1: /* Evaluation */

2019-11-27T06:42:46Z

Evaluation

← Older revision		Revision as of 06:42, 27 November 2019
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	==Evaluation==		==Evaluation==
			===Workup===
	[[File:PMC5028337 13244 2016 503 Fig17 HTML.png\|thumb\|Acute epididymo-orchitis. Contrast-enhanced CT (a, b) shows thickened and engorged left spermatic cord, with inhomogeneous vascularisation of the ipsilateral epididymis (thin arrows) and testis (arrows). Ultrasound (c) reveals hypervascularisation of the epididymis (+).]]		[[File:PMC5028337 13244 2016 503 Fig17 HTML.png\|thumb\|Acute epididymo-orchitis. Contrast-enhanced CT (a, b) shows thickened and engorged left spermatic cord, with inhomogeneous vascularisation of the ipsilateral epididymis (thin arrows) and testis (arrows). Ultrasound (c) reveals hypervascularisation of the epididymis (+).]]
	*[[Urinalysis]]		*[[Urinalysis]]
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	*Ultrasound for equivocal cases		*Ultrasound for equivocal cases
	*Older men should be evaluated for urinary retention		*Older men should be evaluated for urinary retention

			===Diagnosis===
			*Based on clinical exam or ultrasound

	==Management==		==Management==

Rossdonaldson1: /* Evaluation */

2019-11-27T06:42:01Z

Evaluation

← Older revision		Revision as of 06:42, 27 November 2019
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	==Evaluation==		==Evaluation==
			[[File:PMC5028337 13244 2016 503 Fig17 HTML.png\|thumb\|Acute epididymo-orchitis. Contrast-enhanced CT (a, b) shows thickened and engorged left spermatic cord, with inhomogeneous vascularisation of the ipsilateral epididymis (thin arrows) and testis (arrows). Ultrasound (c) reveals hypervascularisation of the epididymis (+).]]
	*[[Urinalysis]]		*[[Urinalysis]]
	**Pyuria seen in half of cases		**Pyuria seen in half of cases