EPIDIDYMITIS

 

Etiology:

  1. Age dependent  - < 40 STD related most commonly. >age 40 E.Coli, Klebsiella. Sometimes can be  "chemical" 2ry to reflux (mainly in children), use of spermicides, condoms.
     
  2. Not  uncommonly presents as epididymo-orchitis

S & S:

  1. Lower abdominal pain, inguinal canal pain, testicular pain.
     
  2. in pain with standing position and relief with laying down and elevating scrotum.
     
  3. Affected testicle commonly appears bigger  than other  testicle and may be slightly  more erythematous.
     
  4. Palpation of the epididymus (on posterior pole) increases pain. One can appreciate fullness.
     
  5. Cremasteric reflex is intact.
     
  6. When both  epididymus and testis becomes involved ® epididymo-orchitis.

DX:

  1. UA may show pyuria. The absence of  WBC on UA does not exclude  the diagnosis.
     
  2. US shows increase in vascularity  c/w inflammation. US also rules-out  torsion and is advisable to obtain.

Treatment:

  1. Age < 40:
    Treat as STD i.e. Ceftriaxone + Azithromycin + NSAID.
     
  2. Age >40:
    Treat with Ciprofloxacin or  Ofloxacin + NSAID.
     
  3. Pt needs admission if  WBC, fever, immunocompromised ( DM,

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