Definition: Inflammation of the epididymis.
–Differential Diagnosis.
-Etiology and treatment are based on patient age and the likely causative organisms.
-Most Common Cause:
–Children younger than 14 years: Reflux of urine into the ejaculatory ducts.
–Sexually active men age 14 to 35 years: GC / CT are the most common pathogens. Tx: Ceftriaxone 250mg IM x 1 dose + Doxycycline 100mg BID x 10 days.
–Men who have anal sex: Also cover for enteric organisms. Tx: Ceftriaxone 250 mg IM + Levofloxacin 500 mg PO QD x 10d or ofloxacin 300 mg PO BID x 10d.
–Men ≥ 35 years old: Cover for enteric bacteria transported by reflux of urine into the ejaculatory ducts 2/2 bladder outlet obstruction. Tx: levofloxacin or ofloxacin alone is sufficient.
—//—
“Acute epididymitis is often the result of descending infection caused by urinary tract pathogens. When the infection involves the epididymis and testis (epididymo-orchitis), sonography will frequently show an enlarged heterogeneous testis with increased color flow.
In sexually active men under age 35, acute epididymitis is caused most frequently by Chlamydia trachomatis and less commonly by Neisseria gonorrhoeae. Clinical features suggestive of urethritis may
Clinical features suggestive of urethritis may be absent (subclinical urethritis). Epididymitis in men who have practiced unprotected insertive rectal intercourse is often caused by Enterobacteriaceae. These men usually do not have urethritis but do have bacteriuria.
Treatment of acute epididymo-orchitis consists of administering appropriate antibiotics for the treatment of both gonorrhea and Chlamydia infections. Additional antibiotic coverage may be indicated based on the patient’s sexual history.
Unilateral absent flow on color and spectral Doppler sonography is a highly sensitive and specific finding in acute testicular torsion and emergent urology referral is indicated. Heterogeneous echotexture of the testis is a common finding in sonograms performed to evaluate acute scrotal pain, regardless of the cause. There is no role for repeat ultrasonography or watchful waiting in patients with acute epididymo-orchitis (SOR C).
Ref: Stengel JW, Remer EM: Sonography of the scrotum: Case-based review. AJR Am J Roentgenol 2008;190(6 Suppl):S35-S41. 2) Longo DL, Fauci AS, Kasper DL, et al (eds): Harrison’s Principles of Internal Medicine, ed 18. McGraw-Hill, 2012, pp 1095-1111. ” ABFM
Reference
http://www.aafp.org/afp/2016/1101/p723.html