Epididymitis

General
  • Men between 14 and 35 years of age are most often affected, and Chlamydia trachomatis and Neisseria gonorrhoeae are the most common pathogens in this age group.
  • In other age groups, coliform bacteria are the primary pathogens.
Symptoms
  • Men with epididymitis and orchitis typically present with a gradual onset of scrotal pain and symptoms of lower urinary tract infection, including fever.
  • This presentation helps differentiate epididymitis and orchitis from testicular torsion, which is a surgical emergency.
Diagnosis
  • Typical physical findings include a swollen, tender epididymis or testis located in the normal anatomic position with an intact ipsilateral cremasteric reflex.
  • Laboratory studies, including urethral Gram stain, urinalysis and culture, and polymerase chain reaction assay for C. trachomatis and N. gonorrhoeae, help guide therapy.
Treatment
  • Initial outpatient therapy is empirical and targets the most common pathogens.
  • When C. trachomatis and N. gonorrhoeae are suspected, ceftriaxone and doxycycline are recommended.
  • When coliform bacteria are suspected, ofloxacin or levofloxacin is recommended.

Am Fam Physician. 2009 Apr 1;79(7):583-587.

Let’s just check a troponin…

TropMakam

A 73 year old male with DM2, HLD, HTN, CKD stage 3, and PVD presents with crushing, substernal chest pain of 2 hours duration and dynamic ST changes on a series of EKGs. Well, you better check that troponin and get in touch with cardiology! But what about that 45 year old male with atypical chest pain and no risk-factors. Just go ahead and check with cardiac biomarkers? According to a new study in JAMA by our own Drs. Makam and Nguyen, the measurement of cardiac biomarkers in the emergency room may be excessive. Despite a broad definition of coronary symptoms (chest pain, nausea, vomiting, heartburn, upper abdominal pain, palpitations, shortness of breath or other breathing problems, general malaise, fainting or dizziness, sweating, fluid abnormality, edema, jaw pain, neck pain, or arm pain), they found that nearly 30% of all patients in the ER that were tested with cardiac biomarkers actually exhibited no symptoms of a heart attack. This practice, however, seems to extend to the inpatient side: among those who were hospitalized, ~35% were tested for cardiac markers despite showing no symptoms of a heart attack. Furthermore, their data suggests that between 2009-2011, this testing lead to 1.7 million false-positive results. For more information, check out the entire article here.

loadBinary_004