Epididymitis is an infection associated with inflammation and pain of the epididymis and testicle. It is one of the most common causes of acute scrotal pain in patients presenting to the emergency room (ER). Epididmytis and orchitis may be infectious or non-infectious. Often times, cases are associated with an underlying cause of chlamydia or gonorrhea, and Escherichia coli (E.coli). Epididymitis and orchitis can occur together, and is called epididymo-orchitis or they can occur separately. There are roughly 600 000 cases of epididymitis annually in the United States. It affects all age groups and represents the most common cause of acute pain in the out patient setting. The etiology, diagnostic evaluation, and treatment are different, in regards to the patient's age. (Cureus. 2021).
Acute epididymitis is a condition localized to the epididymis, but can be associated with orchitis in about 50% of cases. Orchitis alone is usually uncommon, and is generally not related to any sexually transmitted infections (STIs). Some infections that can lead to orchitis are Coxsackie-B virus, mumps, or bacteria spreading through other sources.(Cureus. 2021).
Epididymo-orchitis typically presents as pain in only one side of the scrotum, that progressively worsens over the course of days. It can manifest as generalized or bilateral testicular tenderness, as well as swelling in the testicles, and dysuria (painful urination). Advanced presentation may include fever, nausea and other systemic symptoms. According to (Cureus.2021). The pathophysiology of infectious epdidiymitis is not very clear. However, it may be caused from the backflow of infected urine into the ejaculatory duct.
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Emergency Room Management
Male patient presented to the ER with complaints of scrotal pain. Pain is one of the primary symptoms. Although there can be other associated symptoms such as fever, nauea or vomiting. One of the first things the ER provider thinks of are the diferential diagnoses. These can include, scrotal abscess, scrotal cellulitis, spermatocele, testicular torsion, testicular tumour, and testicular rupture.
If you are a young male and your only symptom is unilateral testicular pain, the provider will immediately order an ultrasound to rule out the presence of torsion. You will also need to provide a urine specimen to test for infection, which include STIs, depending on your age. A urine culture will also be done, but results are given at a later date. It usually takes 24hrs for results to be obtained. If you had other symptoms such as fever and chills, then blood specimen will be drawn to check for systemic infection.
Antibiotics
For acute epididymitis where STI is suspected, your provider may order Ceftriaxone 500 mg intramuscular as a single dose. You may also receive a script for Doxycycline 100mg orally twice daily for 10 days. Azithromycin and Levaquin may also be prescribed, depending on your individual circumstances. If you are not well-enough to go home, you may be admitted for IV antibiotics. At home management includes scrotal elevation and pain medication
Always follow the instructions of your health care provider and seek medical attention where necessary.
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