Updated: 2/12/2018


Review Topic
  • epididymitisA 20-year-old man presents with left-sided testicular pain and swelling. He has a past medical history of multiple sexually transmitted infections. On physical exam, his left scrotum and testicle are erythematous, indurated, and tender to palpation. An ultrasound reveals a thickened epididymis. He is sent to the lab for testing for sexually transmitted diseases.
  • Clinical definition
    • inflammation of epididymis with symptoms of < 6 weeks
  • Epidemiology
    • incidence
      • 25 per 100,000 persons
    • demographics
      • men 18-35 years old
    • risk factors
      • sexual activity
      • bladder outlet obstruction
  • Etiology
    • pathogens from sexually transmitted infections in men less than 35 years of age
      • Neisseria gonorrhoeae
      • Chlamydia trachomatis
    • urinary tract pathogens in men greater than 35 years of age 
      • Escherichia coli
  • Pathogenesis
    • consequence of sexually transmitted disease or urinary tract infection
      • retrograde ascent of pathogen
    • bladder outlet obstruction
      • bacteriuria and subsequent retrograde ascent of pathogen
  • Prognosis
    • resolves with antibiotics
  • Symptoms
    • testicular pain and often unilateral
    • lower abdominal pain
    • urinary frequency or urgency
    • urinary dysuria
  • Physical exam
    • fever
    • testicular erythema, tenderness, and induration
    • cremasteric reflex intact
    • Prehn's sign
      • decrease in pain with scrotal elevation
  • Ultrasound
    • indications
      • to rule out testicular torsion
    • findings
      • enlarged and thick epididymis
      • increased blood flow
      • may also find reactive hydrocele
  • Urine
    • positive leukocyte esterase
    • 10 or more wbc/hpf
    • nucleic amplification testing for Chlamydia and Neisseria
  • Testicular torsion
    • absent cremasteric reflex
  • Medical
    • antibiotics guided by sexual and urologic history
      • ceftriaxone and doxycycline
        • for sexually transmitted diseases
      • fluoroquinolone
        • for enteric pathogens
  • Sepsis
  • Testicular atrophy

Please rate topic.

Average 4.0 of 1 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Topic COMMENTS (2)
Private Note