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Key Features

  • Painful enlargement of the epididymis, relieved by scrotal elevation

  • Fever and irritative voiding symptoms are common

  • In advanced cases, infection can spread to the testis and entire scrotal contents tender to palpation

  • Sexually transmitted form

    • Typically in men under age 40

    • Associated with urethritis

    • Caused by Chlamydia trachomatis or Neisseria gonorrhoeae

  • Nonsexually transmitted form

    • In older men, associated with urinary tract infections and prostatitis

    • Caused by gram-negative rods

Clinical Findings

  • Symptoms can follow acute physical strain, trauma, or sexual activity

  • Associated symptoms of urethritis and urethral discharge or cystitis (irritative voiding symptoms)

  • Pain in the scrotum may radiate along the spermatic cord

  • Fever and scrotal swelling

  • Differential diagnosis

    • Tumors of the testis

    • Testicular torsion

Diagnosis

  • Complete blood count: leukocytosis and left shift

  • Sexually transmitted form

    • Perform Gram stain of urethral discharge

    • Results may show white cells and gram-negative intracellular diplococci (N gonorrhoeae) or white cells without visible organisms (nongonococcal urethritis, C trachomatis)

  • Nonsexually transmitted form

    • Perform urinalysis

    • Results may show pyuria, bacteriuria, hematuria

    • Urine cultures may reveal pathogen

Treatment

  • Sexually transmitted variety: antibiotics for 10–21 days, treat sexual partner also

  • Nonsexually transmitted variety: antibiotics for 21–28 days

  • Evaluate urinary tract to identify underlying disease

  • Bed rest with scrotal elevation

  • Prompt treatment usually results in a favorable outcome

  • Delayed or inadequate treatment may result in epididymo-orchitis, decreased fertility, abscess formation

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