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.