Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 23-03: Genitourinary Tract Infections + Key Features Download Section PDF Listen +++ ++ 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 the entire scrotal contents become tender to palpation Sexually transmitted form Typically in men under age 35 Associated with urethritis Caused by Chlamydia trachomatis or Neisseria gonorrhoeae Nonsexually transmitted form In men aged 35 years and older, associated with urinary tract infections and prostatitis Caused by enteric gram-negative rods + Clinical Findings Download Section PDF Listen +++ ++ Symptoms may follow chronic dysfunctional voiding, urinary retention, sexual activity or trauma Associated symptoms of urethritis (pain at the tip of the penis and urethral discharge) or cystitis (irritative voiding symptoms) Pain in the scrotum may radiate along the spermatic cord or to the flank Scrotal swelling and tenderness are usually apparent Severe cases may develop systemic symptoms such as fever Early in the course, the epididymis may be distinguishable from the testis; however, later the two may appear as one enlarged, tender mass A reactive hydrocele may develop The prostate may be tender on rectal examination Differential diagnosis Tumors of the testis Testicular torsion Distal ureteral stone + Diagnosis Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ Sexually transmitted Intramuscular injection of ceftriaxone plus 10 days of oral doxycycline Any sexual partners from the preceding 60 days must be evaluated and treated as well Men who practice insertive anal intercourse receive a single intramuscular injection of ceftriaxone (250 mg) and 10 days of a fluoroquinolone (ciproflxacin 500 mg twice daily) to cover sexually transmitted and enteric organisms Nonsexually transmitted Treated for 10 days with a fluoroquinolone, at which time evaluation of the urinary tract is warranted to identify underlying disease Evaluate urinary tract to identify underlying disease Bed rest and ice with scrotal elevation Prompt treatment usually results in a favorable outcome Symptoms and signs of epididymitis that do not subside within 3 days require reevaluation of the diagnosis and therapy If significant scrotal swelling has developed, this may take 4 weeks to resolve Delayed or inadequate treatment may result in epididymo-orchitis, decreased fertility, abscess formation