HWN Suggests

Positively Painful Private Parts IV: Epididymitis

In terms of etiology you should first assess whether the patient is sexually active? This adds chlamydia and gonorrhea to the fray. Otherwise E.coli is the most common bacterial cause. Overall most cases don’t have an easily identifable proximate infectious provocateur. You can tell patients “it’s probably a virus,” but what do we know. There is also an association with mycoplasma, though it is limited to case series. You can make the diagnosis clinically, and obtain an ultrasound if you aren’t 100% sure. Any sexually active male should have testing for STDs (include HIV and syphilis while you’re at it) and either treat empirically or wait on your GC and chlamydial DNA studies. Prepubertal…

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Featured

 EM@3AM – Epididymitis

In children presenting with epididymitis (absent indications/findings consistent with sexual abuse) => suspect anatomic urinary tract abnormality.

Articles of Interest

A Day in the Life of the Epididymis

The epididymis has been on my mind recently. The Epi-WHAT-amus? What is that? Well, for one, it’s probably the shortest 5-syllable word you’ve ever heard. And, it happens to be the name of an organ that can spell the difference between being a fertile or infertile guy.

Epididymitis: It's a Real Pain in the...

The cause of epididymitis is often not apparent. Occasionally it is an acute STD, with Chlamydia or gonococcus as the causative organism, but most of the time this is not the case. Recurrent minor trauma, as in bicycle riders, can sometimes be the cause. Most of the time the cause of epididymitis is not apparent. Epididymitis is a close kin to prostatitis, and sometimes both conditions are found at the same time in a patient. Epididymitis can be a complication of vasectomy, usually in the period shortly after the surgery if this is the cause. Differentiation of epididymitis from cancer of the testis is obviously very important...

Why do old guys get epididymitis?

Sperm are made in the testes. The epididymis is a structure in the male testicle, sitting on top of each testis. Its job is to carry sperm from the testis through the vas deferens and ejaculatory ducts into the urethra. However, in older men with enlarged prostate glands, there is extra pressure in the bladder while voiding, because the urethra goes right through the prostate gland, which makes most of the fluid in semen. The high pressure can cause the urine to flow backward through the urethra (the tube that carries urine and semen through the penis) into the epididymis — and even into the testes themselves, where urine does not belong.

Resources

Antibiotic Therapy for Epididymitis

While the condition is often a result of sexual activity, other risk factors may include prolonged sitting, bicycle or motorcycle riding, prostatic obstruction, and certain medications. Empirical antibiotic therapy should cover Chlamydia trachomatis, Neisseria gonorrhoeae, and Escherichia coli, the most common infecting pathogens.

Epididymitis and Orchitis: An Overview

When C. trachomatis and N. gonorrhoeae are suspected, ceftriaxone and doxycycline are recommended. When coliform bacteria are suspected, ofloxacin or levofloxacin is recommended.

Epididymitis Basics

It is a quiet morning in the ED. I know it’s difficult to believe. The triage nurse rolls in a young patient who is screaming in pain. “Doc, doc, my n@&* are killing me!” You can’t help but start thinking about a differential diagnosis on your way to interview your new patient.

Epididymitis in Children

One of the great aspects of working in my ED is being surrounded by a multitude of amazing and brilliant teammates. One, Dr. Christyn Magill, recently provoked this Morsel of knowledge: just because it ends in “-itis” does not mean it needs antibiotics! Excellent point! We have covered this previously with Sinusitis, but another excellent example of this notion is Epididymitis!! Let us take a moment to review how Epididymitis in Children...

CDC

Acute epididymitis is a clinical syndrome consisting of pain, swelling, and inflammation of the epididymis that lasts <6 weeks (755). Sometimes the testis is also involved— a condition referred to as epididymo-orchitis. A high index of suspicion for spermatic cord (testicular) torsion must be maintained in men who present with a sudden onset of symptoms associated with epididymitis, as this condition is a surgical emergency.

Clinical Infectious Diseases

This article summarizes the key questions, evidence, and recommendations for the diagnosis and management of epididymitis that were considered in preparation of the 2015 CDC STD treatment guidelines.

Merck Manual

Sometimes there is no infection of any kind. In such cases, doctors believe the epididymis becomes inflamed by reverse flow of urine into the epididymis, perhaps because of straining (as when men lift something very heavy).

StatPearls

The majority of cases of epididymitis occur as a result of bacterial infection. The types of bacterial infection include common urinary pathogens as well as pathogens known to cause sexually transmitted disease. In most cases of epididymitis, infection occurs either as a result of the retrograde flow of urine, most commonly seen in elderly males, or as a result of a sexually transmitted disease, most often encountered in males ages 20 to 40. In males prior to sexual maturity, the most common cause of epididymitis is inflammation that occurs as a result of trauma or repetitive activities such as sports. The possibility of a sexually transmitted disease, however, must be considered even in males prior to sexual maturity due to the possibility of sexual abuse.