Name
EPIDIDYMITIS
DESCRIPTION
DETAIL
CAUSES : 1. Younger than age 35 . Usually chlamydia or Neisseria gonorrhea . Look for serous urethral discharge (chlamydia) or purulent discharge (gonorrhea) 2. Older than age 35 . Coliform bacteria usually, but sometimes Staphylococcus aureus or epidermidis . Often associated with distal urinary tract obstruction . Tuberculosis, if sterile pyuria and nodularity of vas deferens . Sterile urine reflux after transurethral prostatectomy . Granulomatous reaction following bacillus Calmette-Guerin (BCG) intravesical therapy for superficial bladder cancer 3. Prepubertal boys . Usually coliform bacteria . Evaluate for underlying congenital abnormalities, such as vesicoureteral reflux, ectopic ureter, or anorectal malformation (rectourethral fistula) 4. At any age . Amiodarone, an antiarrhythmic agent, may cause a non-infectious epididymitis, that resolves with decreasing the drug dose -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Epididymal congestion following vasectomy β’ Testicular torsion β’ Torsion of appendix testis β’ Mumps orchitis β’ Testicular tumor β’ Testicular trauma β’ Epididymal cyst β’ Spermatocele β’ Hydrocele β’ Varicocele β’ Epididymal adenomatoid tumor β’ Epididymal rhabdomyosarcoma*URINE ROUTINE - Pyuria on urinalysis * leukocytosis * gram stain urethral discharge * ULTRA SOUND EXAM. OF TESTES * scrotum, radionuclide scan DIAGNOSTIC PROCEDURES : Scrotal exploration or aspiration of epididymis (rarely performed
TYPENOTES
RISK FACTORS: UTI, prostatitis, Indwelling urethral catheter, Urethral instrumentation or transurethral surgery, Urethral stricture, Transrectal prostate biopsy, Prostate brachytherapy (seeds) for prostate cancer, Anal intercourse, HIV infectionGENERAL MEASURES : β’ Scrotal elevation β’ Ice pack β’ Spermatic cord block with local anesthesia in severe cases SURGICAL MEASURES : β’ Aspiration of hydrocele to assist examination of scrotal contents and relieve discomfort β’ Vasostomy to drain infected material β’ Scrotal exploration, if uncertain whether this is epididymitis or testicular torsion β’ Drainage of abscesses, epididymectomy, or epididymoorchiectomy in severe cases not responding to antibiotics ACTIVITY : Bedrest for minimum of 1-2 days DRUG(S) OF CHOICE: *. Younger than age 35 for chlamydia . Doxycycline 100 mg po bid for 10 days and ceftriaxone 250 mg IM *. Older men with bacteriuria . Ciprofloxacin (Cipro) 500 mg po bid or Ciprofloxacin (Cipro XL)1000mg q day for 10-14 days . Levofloxacin (Levaquin) 250 mg po q day for 10-14 days . Norfloxacin (Noroxin) 400 mg po bid for 10-14 days . Analgesia . Non-steroidal anti-inflammatory drug (e.g., naproxen or ibuprofen) for mild to moderate pain . Acetaminophen-codeine or acetaminophen-oxycodone for moderate to severe pain *. Septic or toxic patient . Third generation cephalosporin (ceftriaxone 1-2 gm IV/IM every 24 hours) . Aminoglycoside (gentamicin 1 mg/kg IV/IM every 8 hours, adjusted for renal function) after a loading dose of 2 mg/kg ALTERNATIVE DRUGS : β’ Trimethoprim-sulfamethoxazole (Bactrim, Septra) double strength po bid for 10-14 days; increasing bacterial resistance may limit effectiveness β’ Other aminoglycosides or third generation cephalosporin depending on specific pathogen β’ Add rifampin (rifampicin) or vancomycin as required PATIENT MONITORING : Office visits until all signs of infection have cleared PREVENTION/AVOIDANCE: β’ Vasectomy or vasoligation during transurethral surgery β’ Antibiotic prophylaxis for urethral manipulation β’ Early treatment of prostatitis β’ Avoid vigorous rectal examination with acute prostatitis POSSIBLE COMPLICATIONS: β’ Recurrent epididymitis β’ Infertility β’ Fournierβs gangrene (necrotizing synergistic infection) EXPECTED COURSE/PROGNOSIS : β’ Pain improves within 1-3 days, but induration may take several weeks/months to completely resolve β’ If bilateral involvement, sterility may result Pediatric: β’ In prepubertal, may be post-infectious inflammatory condition, treated with analgesics and usually no antibiotics β’ Bacteremia from Haemophilus infl uenzae infection may produce acute epididymitis β’ In adolescent males, must rule out acute testicular torsion Geriatric: Diabetic patients with sensory neuropathy may have little pain despite severe infection/abscess
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
MONTOUX TEST, URINE ROUTINE, URINE CULTURE TEST, TESTICULAR SCAN, COMPLETE BLOOD COUNT, PUS CULTURE TEST
[EPIDIDYMITIS]