Materiały źródłowe

• #1 Epididymitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/epididymitis/diagnosis-treatment/drc-20363854

  To diagnosis epididymitis, your health care provider talks with you about your symptoms and examines your groin. This includes checking for enlarged lymph nodes in your groin and an enlarged testicle on the affected side. Your provider also might do a rectal exam to check for prostate enlargement or tenderness. […] Tests may include: […] STI screening. A narrow swab inserted into the end of your penis collects a sample of any discharge you may have. The sample is checked in the lab for gonorrhea and chlamydia. […] Urine and blood tests. Samples of your urine and blood may be sent to the lab for testing, too. […] Ultrasound. This imaging test uses sound waves to create pictures of your testicles. The test can show if you have testicular torsion. Testicular torsion is a twisting of the testicle that can cut off blood flow. If ultrasound with color Doppler shows lower blood flow to a testicle than is typical, the testicle is twisted. If blood flow is higher than typical, this can help confirm that you have epididymitis. […] Your health care provider may want to see you at a follow-up visit to check that the infection is gone and your symptoms have improved. […] What tests do I need? […] What treatments do you recommend?

• #2 Epididymitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430814/

  Epididymitis is an inflammation of the epididymis, a tubular structure on the testis where sperms mature. […] This activity reviews the presentation, evaluation, and management of epididymitis and highlights the role of the interprofessional team in managing patients with this condition. […] Evaluation of the male patient with scrotal pain should begin with urinalysis. […] A urethral swab is indicated in cases where the sexually transmitted disease is considered likely given the patient’s sexual history. […] Of utmost importance is ruling out the possibility of testicular torsion as a cause of scrotal pain. […] Treatment of epididymitis is based upon identification of the causative organism, though presumptive treatment may be initiated based upon the prevalence of the most typical agents (C. trachomatis, N. gonorrhea, E. coli).

• #3 Epididymitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/17697-epididymitis

  Epididymitis is inflammation of your epididymis (ep-uh-DID-uh-miss) that causes discomfort or pain in your scrotum, testicle or epididymis. […] A healthcare provider will ask you questions about your symptoms and perform a physical examination of your scrotum to look for a tender area or lump. They may also order tests, including: […] Theyll look for the presence of bacteria in a sample of your pee. […] Theyll withdraw a sample of blood and examine it for signs of infection. […] Theyll insert a swab into your urethra and test the swab for STI pathogens (bacteria or viruses), which may require treatment. […] In some cases, they may take images of your scrotum to help make an epididymitis diagnosis. […] If bacteria cause epididymitis, treatment involves antibiotics. […] Most people need to take antibiotics for about one to two weeks.

• #4

  https://www.advocatehealth.com/health-services/urology/epididymitis

  Your provider will perform a physical exam to determine an epididymitis diagnosis. They will review your medical history and examine your scrotum to check for tenderness or lumps. They may also do a rectal exam to check for enlargement of the prostate gland. […] Other tests your provider may use for an epididymitis diagnosis: […] Urine and blood tests: These tests are used to check for bacteria in the blood and urine. […] Ultrasound: A picture is taken of your testicle to rule out testicular torsion or check blood flow to the testicle. […] STI screening: This test involves inserting a narrow swab into the end of your penis to collect a sample of discharge to check for chlamydia and gonorrhea.

• #5 Epididymitis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/epididymitis.htm

  Men who have acute epididymitis typically have unilateral testicular pain and tenderness, hydrocele, and palpable swelling of the epididymis. […] The spermatic cord is usually tender and swollen. Spermatic cord (testicular) torsion, a surgical emergency, should be considered in all cases; however, it occurs more frequently among adolescents and men without evidence of inflammation or infection. […] Bilateral symptoms should increase suspicion of other causes of testicular pain. Radionuclide scanning of the scrotum is the most accurate method for diagnosing epididymitis but it is not routinely available. […] Although ultrasound can demonstrate epididymal hyperemia and swelling associated with epididymitis, it provides minimal diagnostic usefulness for men with a clinical presentation consistent with epididymitis. A negative ultrasound does not rule out epididymitis and thus does not alter clinical management.

• #6 Epididymitis – Wikipedia

  https://en.wikipedia.org/wiki/Epididymitis

  Epididymitis is a medical condition characterized by inflammation of the epididymis, a curved structure at the back of the testicle. Diagnosis is typically based on symptoms. Conditions that may result in similar symptoms include testicular torsion, inguinal hernia, and testicular cancer. Ultrasound can be useful if the diagnosis is unclear. […] Typical findings are redness, warmth, and swelling of the scrotum, with tenderness behind the testicle, away from the middle (this is the normal position of the epididymis relative to the testicle). […] If there is pain relieved by elevation of the testicle, this is called Prehn’s sign, which is, however, non-specific and is not useful for diagnosis. […] Additional tests may be necessary to identify underlying causes. In sexually active men, tests for sexually transmitted infections may be done.

• #7 Epididymitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/epididymitis/diagnosis-treatment/drc-20363854

  To diagnosis epididymitis, your health care provider talks with you about your symptoms and examines your groin. This includes checking for enlarged lymph nodes in your groin and an enlarged testicle on the affected side. Your provider also might do a rectal exam to check for prostate enlargement or tenderness. […] Tests may include: […] STI screening. A narrow swab inserted into the end of your penis collects a sample of any discharge you may have. The sample is checked in the lab for gonorrhea and chlamydia. […] Urine and blood tests. Samples of your urine and blood may be sent to the lab for testing, too. […] Ultrasound. This imaging test uses sound waves to create pictures of your testicles. The test can show if you have testicular torsion. Testicular torsion is a twisting of the testicle that can cut off blood flow. If ultrasound with color Doppler shows lower blood flow to a testicle than is typical, the testicle is twisted. If blood flow is higher than typical, this can help confirm that you have epididymitis. […] Your health care provider may want to see you at a follow-up visit to check that the infection is gone and your symptoms have improved. […] What tests do I need? […] What treatments do you recommend?

• #8 Epididymitis: Causes, Symptoms, and Treatments

  https://www.webmd.com/men/what-is-epididymitis

  Epididymitis Diagnosis […] When you go to the doctor, they will examine your scrotum for signs of infection and ask you questions about your symptoms. They might also do a rectal exam to check your prostate and check for any tenderness. […] If your doctor suspects epididymitis based on the exam, you might get one or more tests. They include: […] Urine sample: You may pee into a cup so a lab can check for signs of an infection. […] Blood sample: This can also find abnormalities or high levels of inflammation in your blood. […] Swab sample: For this test, your doctor inserts a narrow swab into the tip of your penis to get a sample of discharge. This is used to test for chlamydia or gonorrhea. […] Epididymitis ultrasound […] You might also be asked to sit for an ultrasound test, which uses sound waves to produce an image of your scrotum and testicles. If you get one that uses color (Doppler), this can show whether you have abnormal blood flow. […] Your doctor can use an ultrasound test to check for epididymitis along with other health problems, including testicular torsion and testicular cancer.

• #9 Epididymitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/epididymitis/

  Epididymitis is a clinical diagnosis, with patients typically presenting with a gradual onset of pain and swelling of the affected scrotum and a positive Prehn sign. […] Urinalysis and testing for sexually transmitted infections (STIs) can help confirm the diagnosis. […] Epididymitis is a clinical diagnosis. […] Urine and urethral studies help tailor antibiotic therapy and identify the causative organism. […] Imaging is primarily used to rule out testicular torsion but can confirm epididymitis if the diagnosis is uncertain. […] Testing for HIV and syphilis is recommended for all patients with acute epididymitis. […] Duplex ultrasound of the scrotum may be used to rule out testicular torsion and scrotal abscess. […] Findings: An enlarged, hyperemic epididymis with increased blood flow indicates epididymitis.

• #10 Epididymitis – Clinical Features – Management – TeachMeSurgery

  https://teachmesurgery.com/urology/genital-tract/epididymitis/

  Epididymitis is inflammation of the epididymis (inflammation of the testes is termed orchitis). […] The diagnosis of epididymitis is typically a clinical one, however ultrasound imaging of the testes via an US Doppler can be useful to confirm the diagnosis and to rule out any complication (e.g. testicular abscess). […] Specific tests include assessing for the cremasteric reflex, which is intact in cases of epididymitis, and Prehns sign, which when positive is also suggestive of epididymitis. […] Prehns sign can be used to further assess for suspected cases of epididymitis. […] Unfortunately, Prehns sign is unreliable; whilst it has good sensitivity, it has relatively poor specificity, therefore is not used routinely in clinical practice. […] Antibiotic therapy forms the mainstay of treatment, where the antibiotic regimen depends on the suspected cause, and can be started empirically prior to any culture results.

• #11 Epididymitis: An Overview | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/1101/p723.html

  Inflammation of the epididymis, or epididymitis, is commonly seen in the outpatient setting. Epididymitis presents as the gradual onset of posterior scrotal pain that may be accompanied by urinary symptoms such as dysuria and urinary frequency. Physical findings include a swollen and tender epididymis with the testis in an anatomically normal position. […] Acute epididymitis generally presents as the gradual onset of posterior scrotal pain and swelling over one to two days. There may be concurrent symptoms of fever, hematuria, dysuria, and urinary frequency, and the pain may radiate into the lower abdomen. […] Acute epididymitis is a clinical diagnosis. A midstream urinalysis should be obtained to evaluate for an infectious cause. A urine culture should be obtained for all children, and for adults with a positive urinalysis result.

• #12 Epididymitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430814/

  Epididymitis is an inflammation of the epididymis, a tubular structure on the testis where sperms mature. […] This activity reviews the presentation, evaluation, and management of epididymitis and highlights the role of the interprofessional team in managing patients with this condition. […] Evaluation of the male patient with scrotal pain should begin with urinalysis. […] A urethral swab is indicated in cases where the sexually transmitted disease is considered likely given the patient’s sexual history. […] Of utmost importance is ruling out the possibility of testicular torsion as a cause of scrotal pain. […] Treatment of epididymitis is based upon identification of the causative organism, though presumptive treatment may be initiated based upon the prevalence of the most typical agents (C. trachomatis, N. gonorrhea, E. coli).

• #13 Epididymitis Workup: Approach Considerations, Laboratory Findings in Acute Epididymitis and Nonviral Orchitis, Ultrasonography

  https://emedicine.medscape.com/article/436154-workup

  The following laboratory studies may be indicated for suspected epididymitis: Urinalysis – Pyuria or bacteriuria (50%); urine culture indicated for prepubertal and elderly patients […] Complete blood count (CBC) – Leukocytosis […] Gram stain of urethral discharge, if present […] Urethral culture, nucleic acid hybridization, and nucleic acid amplification tests (these tests aid in detection of N gonorrhoeae and C trachomatis) […] Performance of (or referral for) syphilis and HIV testing in patients found positive for C trachomatis or N gonorrhoeae infection […] The use of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to differentiate epididymitis from other causes of acute scrotum is currently under investigation. […] If mumps orchitis is clinically suspected but the diagnosis is in doubt, use immunofluorescent antibody testing to confirm the diagnosis. Urinalysis and culture findings are negative in mumps orchitis.

• #14 Epididymitis | Children’s Hospital of Richmond at VCU

  https://www.chrichmond.org/services/urology/conditions-we-treat/epididymitis/

  Epididymitis may be caused by a bacterial infection occurring along the urinary tract. […] During the physical exam, redness, tenderness and sometimes a swollen lump may be found on the affected side of the scrotum. If epididymitis is suspected, the following tests may be completed to confirm the diagnosis: […] Urinalysis (chemical analysis of urine) and urine culture (checks for bacteria in urine) […] Scrotal ultrasound (painless test that takes pictures of scrotal area) […] Uroflow and bladder scan (tests that measure urine flow rate and how long it takes to empty bladder).

• #15 Epididymitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/17697-epididymitis

  Epididymitis is inflammation of your epididymis (ep-uh-DID-uh-miss) that causes discomfort or pain in your scrotum, testicle or epididymis. […] A healthcare provider will ask you questions about your symptoms and perform a physical examination of your scrotum to look for a tender area or lump. They may also order tests, including: […] Theyll look for the presence of bacteria in a sample of your pee. […] Theyll withdraw a sample of blood and examine it for signs of infection. […] Theyll insert a swab into your urethra and test the swab for STI pathogens (bacteria or viruses), which may require treatment. […] In some cases, they may take images of your scrotum to help make an epididymitis diagnosis. […] If bacteria cause epididymitis, treatment involves antibiotics. […] Most people need to take antibiotics for about one to two weeks.

• #16 Epididymitis Workup: Approach Considerations, Laboratory Findings in Acute Epididymitis and Nonviral Orchitis, Ultrasonography

  https://emedicine.medscape.com/article/436154-workup

  The following laboratory studies may be indicated for suspected epididymitis: Urinalysis – Pyuria or bacteriuria (50%); urine culture indicated for prepubertal and elderly patients […] Complete blood count (CBC) – Leukocytosis […] Gram stain of urethral discharge, if present […] Urethral culture, nucleic acid hybridization, and nucleic acid amplification tests (these tests aid in detection of N gonorrhoeae and C trachomatis) […] Performance of (or referral for) syphilis and HIV testing in patients found positive for C trachomatis or N gonorrhoeae infection […] The use of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to differentiate epididymitis from other causes of acute scrotum is currently under investigation. […] If mumps orchitis is clinically suspected but the diagnosis is in doubt, use immunofluorescent antibody testing to confirm the diagnosis. Urinalysis and culture findings are negative in mumps orchitis.

• #17 Acute Epididymitis: Practice Essentials, Diagnosis, Medical Care

  https://emedicine.medscape.com/article/777181-overview

  The Centers for Disease Control and Prevention (CDC) recommends using the following tests and findings to help diagnose acute epididymitis: […] In a study of 237 patients with acute epididymitis, a causative pathogen was identified in 132 antibiotic-naive patients and in 44 pretreated patients. The primary pathogen was Escherichia coli. Sexually transmitted infections were present in 34 cases (25 patients with C trachomatis). […] Ultrasonography is noninvasive and can help to differentiate epididymitis from testicular torsion. […] A study by Asgari et al suggests that C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR) may be useful in differentiating epididymitis from testicular torsion. In this prospective study, investigators evaluated 120 patients with the diagnosis of acute scrotum; serum CRP and ESR were drawn at the time of admission. Of 46 patients with diagnosed epididymitis, 44 (95.6%) had elevation in CRP levels, and among 23 patients with torsion, 1 (4%) had an elevated CRP level.

• #18 Epididymitis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/epididymitis.htm

  All suspected cases of acute epididymitis should be evaluated for objective evidence of inflammation by one of the following POC tests: Gram, MB, or GV stain of urethral secretions demonstrating 2 WBCs per oil immersion field. […] All suspected cases of acute epididymitis should be tested for C. trachomatis and N. gonorrhoeae by NAAT. Urine is the preferred specimen for NAAT for men. […] Men should be instructed to return to their health care providers if their symptoms do not improve 72 hours after treatment. Signs and symptoms of epididymitis that do not subside in 3 days require reevaluation of the diagnosis and therapy.

• #19 Epididymitis and Orchitis: An Overview | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0401/p583.html/1000

  Epididymitis and orchitis are commonly seen in the outpatient setting. Men between 14 and 35 years of age are most often affected, and Chlamydia trachomatis and Neisseria gonorrhoeae are the most common pathogens in this age group. […] Laboratory studies, including urethral Gram stain, urinalysis and culture, and polymerase chain reaction assay for C. trachomatis and N. gonorrhoeae, help guide therapy. […] Typical physical findings include a swollen, tender epididymis or testis located in the normal anatomic position with an intact ipsilateral cremasteric reflex. […] When epididymitis is suspected, polymerase chain reaction assays for C. trachomatis and N. gonorrhoeae should be performed on urethral swab or urine specimens. […] In addition to a careful history and physical examination, diagnostic studies can help confirm epididymitis and orchitis and detect the causative pathogen. […] A Gram stain and culture of swabbed urethral discharge are recommended to detect urethritis and gonococcal infection. […] If the diagnosis remains unclear, referral and surgical exploration of the scrotum is warranted.

• #20 Acute epididymitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/186

  Acute epididymitis is inflammation of the epididymis causing pain and swelling that develops over the course of a few days and lasts 6 weeks. […] Diagnostic tests include a Gram stain of urethral secretions, and urine specimens for nucleic acid amplification tests for C trachomatis, N gonorrhoeae, and M genitalium (where available). Urine microscopy and culture is also indicated if urinary pathogens are suspected. […] Key diagnostic factors include age 19 years, unilateral scrotal pain and swelling of gradual onset, symptoms 6 weeks’ duration, tenderness, hot, erythematous, swollen hemiscrotum, frequent and painful micturition, and purulent urethral discharge. […] 1st tests to order include Gram stain of urethral secretions, urine dipstick test, urine microscopy, urine culture, nucleic acid amplification test (NAAT) of urethral secretions or first-void urine for Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium.

• #21 STI-associated syndromes guide: Epididymitis – Canada.ca

  https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/sti-associated-syndromes/epididymitis.html

  This guide provides an overview of the management and empiric treatment of sexually transmitted infection (STI) – associated epididymitis, which is an inflammation of the epididymis and vas deferens. […] Acute epididymitis is the most common cause of scrotal pain in adults and is frequently associated with an STI. […] The probability that epididymitis is caused by a sexually transmitted infection (STI), another infection or a non-infectious cause depends on a person’s sexual practises and risk factors for a sexually transmitted and blood-borne infection (STBBI). Acute epididymitis is primarily an infective condition. Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are the most common causes of acute epididymitis in sexually active people. […] Obtain first-void urine (FVU) or urethral swab for nucleic acid amplification tests (NAAT) for CT and GC, plus urethral swab for culture for GC (where available).

• #22 Epididymitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/epididymitis/diagnosis-treatment/drc-20363854

  To diagnosis epididymitis, your health care provider talks with you about your symptoms and examines your groin. This includes checking for enlarged lymph nodes in your groin and an enlarged testicle on the affected side. Your provider also might do a rectal exam to check for prostate enlargement or tenderness. […] Tests may include: […] STI screening. A narrow swab inserted into the end of your penis collects a sample of any discharge you may have. The sample is checked in the lab for gonorrhea and chlamydia. […] Urine and blood tests. Samples of your urine and blood may be sent to the lab for testing, too. […] Ultrasound. This imaging test uses sound waves to create pictures of your testicles. The test can show if you have testicular torsion. Testicular torsion is a twisting of the testicle that can cut off blood flow. If ultrasound with color Doppler shows lower blood flow to a testicle than is typical, the testicle is twisted. If blood flow is higher than typical, this can help confirm that you have epididymitis. […] Your health care provider may want to see you at a follow-up visit to check that the infection is gone and your symptoms have improved. […] What tests do I need? […] What treatments do you recommend?

• #23 Epididymitis: An Overview | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/1101/p723.html

  If testicular torsion is suspected, color Doppler ultrasonography should be ordered immediately. Hyperemia, swelling, and increased blood flow of the epididymis are common ultrasound findings in patients with epididymitis, whereas there is decreased or absent flow in those with testicular torsion. […] Epididymitis is often associated with an elevated C-reactive protein level. […] In patients 14 years and older, empiric antibiotics are recommended based on the most likely causative organism. Goals of treatment include curing microbiologic infection; preventing the spread of N. gonorrhoeae or C. trachomatis infection to sex partners; and preventing complications from untreated epididymitis, including infertility and chronic pain. […] Acute epididymitis can usually be treated in the outpatient setting with follow-up within one week to evaluate for clinical response to treatment.

• #24 Epididymitis Workup: Approach Considerations, Laboratory Findings in Acute Epididymitis and Nonviral Orchitis, Ultrasonography

  https://emedicine.medscape.com/article/436154-workup

  Amiodarone plasma levels or antibodies are not helpful in the diagnosis of amiodarone-induced epididymitis. […] Use imaging studies to help distinguish acute epididymitis from the more ominous testicular torsion. However, clinical judgment must guide interpretation of imaging results, as they are neither 100% sensitive nor specific. […] Confirmatory imaging is unnecessary in a patient with a clear history consistent with epididymitis; ultrasonographic results are positive in only 69% of patients with clinical epididymitis. […] MRI has high sensitivity and specificity for testicular torsion and is useful for differentiating epididymitis and testicular torsion when ultrasound findings are inconclusive. […] Radiologic studies are recommended in children who have bacteruria and acute epididymitis in order to evaluate for structural abnormalities (found in 50% of these patients).

• #25 Epididymitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/epididymitis?lang=us

  Epididymitis (plural: epididymitides) refers to inflammation of the epididymis and may be associated with inflammation extending to the testis, in which case the term epididymo-orchitis is used. This should be distinguished from isolated orchitis, which is, by comparison, much less common. […] The infection usually originates in the bladder or prostate gland, spreads through the ductus deferens and the lymphatics of the spermatic cord to the epididymis, and finally reaches the testis, causing epididymo-orchitis. Due to this progression, infection starts in the tail of the epididymis. […] The epididymal tail is the most affected region, and reactive hydrocele and scrotal wall thickening are frequently present. As the infection spreads, it can ascend the body and later the head of the epididymis.

• #26 Epididymitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/epididymitis?lang=us

  Pulsed wave Doppler interrogation yielding an epididymal peak systolic velocity (PSV) greater than 15 cm/sec is highly suggestive of epididymitis, especially when the PSV on the affected side is significantly higher than the unaffected (with a ratio 1.7). […] In isolated epididymitis increased curvilinear activity is seen laterally, corresponding to the inflamed epididymis.

• #27 Epididymitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/epididymitis?lang=us

  Pulsed wave Doppler interrogation yielding an epididymal peak systolic velocity (PSV) greater than 15 cm/sec is highly suggestive of epididymitis, especially when the PSV on the affected side is significantly higher than the unaffected (with a ratio 1.7). […] In isolated epididymitis increased curvilinear activity is seen laterally, corresponding to the inflamed epididymis.

• #28 Epididymitis Workup: Approach Considerations, Laboratory Findings in Acute Epididymitis and Nonviral Orchitis, Ultrasonography

  https://emedicine.medscape.com/article/436154-workup

  Amiodarone plasma levels or antibodies are not helpful in the diagnosis of amiodarone-induced epididymitis. […] Use imaging studies to help distinguish acute epididymitis from the more ominous testicular torsion. However, clinical judgment must guide interpretation of imaging results, as they are neither 100% sensitive nor specific. […] Confirmatory imaging is unnecessary in a patient with a clear history consistent with epididymitis; ultrasonographic results are positive in only 69% of patients with clinical epididymitis. […] MRI has high sensitivity and specificity for testicular torsion and is useful for differentiating epididymitis and testicular torsion when ultrasound findings are inconclusive. […] Radiologic studies are recommended in children who have bacteruria and acute epididymitis in order to evaluate for structural abnormalities (found in 50% of these patients).

• #29 Epididymitis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/001279.htm

  Epididymitis is swelling (inflammation) of the tube that connects the testicle with the vas deferens. The tube is called the epididymis. […] Physical exam will show a red, tender lump on the affected side of the scrotum. You may have tenderness in a small area of the testicle where the epididymis is attached. A large area of swelling may develop around the lump. […] These tests may be performed: Complete blood count (CBC), Doppler ultrasound, Testicular scan (nuclear medicine scan), Urinalysis and culture (you may need to give several specimens, including initial stream, mid-stream, and after a prostate massage), Tests for chlamydia and gonorrhea. […] You can prevent complications if you get diagnosed and treated early.

• #30 Epididymitis Workup: Approach Considerations, Laboratory Findings in Acute Epididymitis and Nonviral Orchitis, Ultrasonography

  https://emedicine.medscape.com/article/436154-workup

  Amiodarone plasma levels or antibodies are not helpful in the diagnosis of amiodarone-induced epididymitis. […] Use imaging studies to help distinguish acute epididymitis from the more ominous testicular torsion. However, clinical judgment must guide interpretation of imaging results, as they are neither 100% sensitive nor specific. […] Confirmatory imaging is unnecessary in a patient with a clear history consistent with epididymitis; ultrasonographic results are positive in only 69% of patients with clinical epididymitis. […] MRI has high sensitivity and specificity for testicular torsion and is useful for differentiating epididymitis and testicular torsion when ultrasound findings are inconclusive. […] Radiologic studies are recommended in children who have bacteruria and acute epididymitis in order to evaluate for structural abnormalities (found in 50% of these patients).

• #31 Epididymitis And Orchitis – Harvard Health

  https://www.health.harvard.edu/a_to_z/epididymitis-and-orchitis-a-to-z

  You will describe your symptoms. Your doctor will ask questions about your medical history, surgical history and sexual activity. He or she then will examine you, including your genital area. […] You may need one or more of the following tests: […] Urinalysis. A chemical analysis of urine. […] Urine cultures. These determine whether bacteria are present in the urine, indicating a possible UTI. […] Laboratory tests. Of fluid taken from inside the urethra or of discharge from the penis. […] Blood tests. To check for signs of infection, including STDs. […] Symptoms may be so severe that the doctor must test to see if you have testicular torsion. This is a sudden, painful twisting of the testicle that cuts off the testicle’s blood supply. […] You may need an ultrasound if there is a concern for testicular torsion. This is a painless test that uses sound waves. In this case, it measures blood flow in the testicles. […] Radionuclide scanning is another test you may need. In this test, a small amount of a radioactive isotope is injected into your blood. If the isotope collects near the testicle, it may indicate testicular torsion.

• #32 Epididymitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430814/

  The differential diagnoses of epididymitis include but are not limited to the following: Epididymal congestion following vasectomy, Hydrocele, Orchitis, Referred or radicular pain, Scrotal trauma, Spermatocele, Testicular trauma, Testicular seminoma, Tunica vaginalis tumor, Urinary tract infection. […] Epididymitis is a frequent presentation to the emergency department. However, the diagnosis can often be confused with testicular torsion, which is a surgical emergency. […] The outcomes for most men with epididymitis are excellent, but relapses may occur in patients who are not compliant with therapy.

• #33 Epididymitis – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/penile-and-scrotal-disorders/epididymitis

  Diagnosis of epididymitis is confirmed by finding swelling and tenderness of the epididymis. However, unless findings are clearly isolated to the epididymis, testicular torsion must also be considered, particularly in patients 30 years; immediate color Doppler ultrasonography is indicated. […] Urethritis suggests that the cause of epididymitis is a sexually transmitted pathogen, and a urethral swab is sent for gonococcus and chlamydia nucleic acid amplification testing (NAAT) or culture. Otherwise, the infecting organism usually can be identified by urine culture. Urinalysis and culture are normal in nonbacterial causes. […] Diagnose epididymitis clinically and exclude testicular torsion by clinical findings or, if necessary, by color Doppler ultrasonography.

• #34 Epididymitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430814/

  The differential diagnoses of epididymitis include but are not limited to the following: Epididymal congestion following vasectomy, Hydrocele, Orchitis, Referred or radicular pain, Scrotal trauma, Spermatocele, Testicular trauma, Testicular seminoma, Tunica vaginalis tumor, Urinary tract infection. […] Epididymitis is a frequent presentation to the emergency department. However, the diagnosis can often be confused with testicular torsion, which is a surgical emergency. […] The outcomes for most men with epididymitis are excellent, but relapses may occur in patients who are not compliant with therapy.

• #35 Are Haematological Parameters Reliable for Differential Diagnosis of Testicular Torsion and Epididymitis? – Journal of Urological Surgery

  https://jurolsurgery.org/articles/are-haematological-parameters-reliable-for-differential-diagnosis-of-testicular-torsion-and-epididymitis/doi/jus.galenos.2019.2808

  Objective: Acute scrotum is a urological emergency that can result in loss of the testis if the differential diagnosis is not made immediately. Testicular torsion (TT) and epididymo-orchitis (EO) are the two most common causes of acute scrotum. Our aim was to evaluate the utility of haematological parameters for the diagnosis of both TT and EO and for differential diagnosis of these two conditions. […] Although, these tests were insufficient to differentiate TT from EO, we think that they may narrow the indications for emergent exploration for acute scrotum. […] Although, these tests were insufficient to differentiate testicular torsion and epididymo-orchitis, can narrow the indications for exploration for acute scrotum. However, exploration still remains important in suspected cases. […] Several hematological parameters have been studied to be used in the differential diagnosis of both diseases.

• #36 Acute Epididymitis: Practice Essentials, Diagnosis, Medical Care

  https://emedicine.medscape.com/article/777181-overview

  The Centers for Disease Control and Prevention (CDC) recommends using the following tests and findings to help diagnose acute epididymitis: […] In a study of 237 patients with acute epididymitis, a causative pathogen was identified in 132 antibiotic-naive patients and in 44 pretreated patients. The primary pathogen was Escherichia coli. Sexually transmitted infections were present in 34 cases (25 patients with C trachomatis). […] Ultrasonography is noninvasive and can help to differentiate epididymitis from testicular torsion. […] A study by Asgari et al suggests that C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR) may be useful in differentiating epididymitis from testicular torsion. In this prospective study, investigators evaluated 120 patients with the diagnosis of acute scrotum; serum CRP and ESR were drawn at the time of admission. Of 46 patients with diagnosed epididymitis, 44 (95.6%) had elevation in CRP levels, and among 23 patients with torsion, 1 (4%) had an elevated CRP level.

• #37 Are Haematological Parameters Reliable for Differential Diagnosis of Testicular Torsion and Epididymitis? – Journal of Urological Surgery

  https://jurolsurgery.org/articles/are-haematological-parameters-reliable-for-differential-diagnosis-of-testicular-torsion-and-epididymitis/doi/jus.galenos.2019.2808

  According to our findings, leukocyte count does not appear to be helpful in the differentiating TT from EO. […] Our findings revealed that however, these tests were insufficient to differentiate TT from EO, but can differentiate TT and EO from other causes of acute scrotum. We suggest that the use of haematological parameters in patients presenting with acute scrotum narrows the indications for exploration but does not eliminate it.

• #38 Epididymitis | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/epididymitis

  Epididymitis is inflammation of the epididymis, usually caused by an infection. […] Epididymitis can be diagnosed through: physical examination, medical history, urine tests, STI tests, blood tests, ultrasound of the testes. […] It can be hard to tell the difference between epididymitis and testicular torsion especially in younger people. […] Tests are needed to distinguish chronic epididymitis from other disorders that cause constant scrotal pain. […] Chronic epididymitis is difficult to treat.

• #39 Are Haematological Parameters Reliable for Differential Diagnosis of Testicular Torsion and Epididymitis? – Journal of Urological Surgery

  https://jurolsurgery.org/articles/are-haematological-parameters-reliable-for-differential-diagnosis-of-testicular-torsion-and-epididymitis/doi/jus.galenos.2019.2808

  Objective: Acute scrotum is a urological emergency that can result in loss of the testis if the differential diagnosis is not made immediately. Testicular torsion (TT) and epididymo-orchitis (EO) are the two most common causes of acute scrotum. Our aim was to evaluate the utility of haematological parameters for the diagnosis of both TT and EO and for differential diagnosis of these two conditions. […] Although, these tests were insufficient to differentiate TT from EO, we think that they may narrow the indications for emergent exploration for acute scrotum. […] Although, these tests were insufficient to differentiate testicular torsion and epididymo-orchitis, can narrow the indications for exploration for acute scrotum. However, exploration still remains important in suspected cases. […] Several hematological parameters have been studied to be used in the differential diagnosis of both diseases.

• #40 Epididymitis and Orchitis: An Overview | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0401/p583.html/1000

  Epididymitis and orchitis are commonly seen in the outpatient setting. Men between 14 and 35 years of age are most often affected, and Chlamydia trachomatis and Neisseria gonorrhoeae are the most common pathogens in this age group. […] Laboratory studies, including urethral Gram stain, urinalysis and culture, and polymerase chain reaction assay for C. trachomatis and N. gonorrhoeae, help guide therapy. […] Typical physical findings include a swollen, tender epididymis or testis located in the normal anatomic position with an intact ipsilateral cremasteric reflex. […] When epididymitis is suspected, polymerase chain reaction assays for C. trachomatis and N. gonorrhoeae should be performed on urethral swab or urine specimens. […] In addition to a careful history and physical examination, diagnostic studies can help confirm epididymitis and orchitis and detect the causative pathogen. […] A Gram stain and culture of swabbed urethral discharge are recommended to detect urethritis and gonococcal infection. […] If the diagnosis remains unclear, referral and surgical exploration of the scrotum is warranted.

• #41 Epididymitis Workup: Approach Considerations, Laboratory Findings in Acute Epididymitis and Nonviral Orchitis, Ultrasonography

  https://emedicine.medscape.com/article/436154-workup

  Scrotal exploration or aspiration of the epididymis is rarely needed. If it is needed, it is performed by a urologist. Perform a scrotal exploration if torsion or tumor cannot be ruled out and for the complications of acute epididymitis and orchitis (eg, abscess, pyocele, testicular infarction). Diagnosis of intrascrotal disorders is often confirmed during orchiectomy. […] The WBC count may be elevated with a left shift (10,000-30,000 cells/L). A midstream urine culture and Gram stain are useful in guiding therapy. Urinalysis findings are positive for pyuria in only 25% of patients and are sterile in 40-90% of patients. […] Obtain a urethral swab culture (before void, after prostate massage) for gonorrheal and chlamydial infections if the patient is in the at-risk age group or if the patient is older than 40 years and not monogamous.

• #42 Epididymitis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/epididymitis.htm

  All suspected cases of acute epididymitis should be evaluated for objective evidence of inflammation by one of the following POC tests: Gram, MB, or GV stain of urethral secretions demonstrating 2 WBCs per oil immersion field. […] All suspected cases of acute epididymitis should be tested for C. trachomatis and N. gonorrhoeae by NAAT. Urine is the preferred specimen for NAAT for men. […] Men should be instructed to return to their health care providers if their symptoms do not improve 72 hours after treatment. Signs and symptoms of epididymitis that do not subside in 3 days require reevaluation of the diagnosis and therapy.

• #43 Epididymitis Workup: Approach Considerations, Laboratory Findings in Acute Epididymitis and Nonviral Orchitis, Ultrasonography

  https://emedicine.medscape.com/article/436154-workup

  Amiodarone plasma levels or antibodies are not helpful in the diagnosis of amiodarone-induced epididymitis. […] Use imaging studies to help distinguish acute epididymitis from the more ominous testicular torsion. However, clinical judgment must guide interpretation of imaging results, as they are neither 100% sensitive nor specific. […] Confirmatory imaging is unnecessary in a patient with a clear history consistent with epididymitis; ultrasonographic results are positive in only 69% of patients with clinical epididymitis. […] MRI has high sensitivity and specificity for testicular torsion and is useful for differentiating epididymitis and testicular torsion when ultrasound findings are inconclusive. […] Radiologic studies are recommended in children who have bacteruria and acute epididymitis in order to evaluate for structural abnormalities (found in 50% of these patients).

• #44 Epididymitis: Causes (Etiology) and Treatment

  https://www.urology-textbook.com/epididymitis.html

  Epididymitis: Signs and Symptoms […] Diagnosis of Epididymitis […] Urethral swab and PCR testing for gonorrhea or chlamydial infection if STD are possible. […] Urine analysis: Urine sediment: leukocyturia. […] Urine culture: can identify the pathogen. […] Testicular ultrasound examination is mandatory for differential diagnosis of testicular torsion. In epididymitis, ultrasound imaging shows an enlarged epididymis, often with a hydrocele. […] It is important to identify abscess formation or signs of orchitis and rule out testicular torsion with Doppler ultrasound. […] If there is doubt about the diagnosis of epididymitis, a surgical exploration of the scrotum is necessary to exclude testicular torsion. […] Uroflowmetry, exclusion of residual urine in the bladder, retrograde urethrography or cystogram are options to diagnose voiding dysfunction after healed epididymitis.

• #45 Diagnosis and Management of Epididymitis | Abdominal Key

  https://abdominalkey.com/diagnosis-and-management-of-epididymitis/

  Epididymitis is a common and morbid condition seen across a wide age range. […] Management of epididymitis is often difficult, but relies on clinical expertise and the use of established clinical guidelines. […] Multiple objective findings of epididymitis have been identified and, in variable degrees, may include positive urine cultures, fever, erythema of the scrotal skin, leukocytosis, urethritis, hydrocele, and involvement of the adjacent testis. […] The true prevalence of epididymitis is unknown. […] Although epididymitis has been reported at any time from infancy up to 90 years of age, it is the fifth most common urologic diagnosis in men between the ages of 18 and 50, with a mean patient age at presentation of 41 years. […] Patients presenting with a clinical diagnosis of epididymitis should undergo testing for the appropriate bacteria according to the Centers for Disease Control (CDC) guidelines. […] Urine should be examined by urinary dipstick as well as microscopy. […] Patients with a positive dipstick or microscopy should have urine sent for definitive culture.

• #46 Epididymitis Workup: Approach Considerations, Laboratory Findings in Acute Epididymitis and Nonviral Orchitis, Ultrasonography

  https://emedicine.medscape.com/article/436154-workup

  Scrotal exploration or aspiration of the epididymis is rarely needed. If it is needed, it is performed by a urologist. Perform a scrotal exploration if torsion or tumor cannot be ruled out and for the complications of acute epididymitis and orchitis (eg, abscess, pyocele, testicular infarction). Diagnosis of intrascrotal disorders is often confirmed during orchiectomy. […] The WBC count may be elevated with a left shift (10,000-30,000 cells/L). A midstream urine culture and Gram stain are useful in guiding therapy. Urinalysis findings are positive for pyuria in only 25% of patients and are sterile in 40-90% of patients. […] Obtain a urethral swab culture (before void, after prostate massage) for gonorrheal and chlamydial infections if the patient is in the at-risk age group or if the patient is older than 40 years and not monogamous.

• #47

• #48 Epididymitis: An Overview | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/1101/p723.html

  Inflammation of the epididymis, or epididymitis, is commonly seen in the outpatient setting. Epididymitis presents as the gradual onset of posterior scrotal pain that may be accompanied by urinary symptoms such as dysuria and urinary frequency. Physical findings include a swollen and tender epididymis with the testis in an anatomically normal position. […] Acute epididymitis generally presents as the gradual onset of posterior scrotal pain and swelling over one to two days. There may be concurrent symptoms of fever, hematuria, dysuria, and urinary frequency, and the pain may radiate into the lower abdomen. […] Acute epididymitis is a clinical diagnosis. A midstream urinalysis should be obtained to evaluate for an infectious cause. A urine culture should be obtained for all children, and for adults with a positive urinalysis result.

• #49 Epididymitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/epididymitis/symptoms-causes/syc-20363853

  Epididymitis is usually treated with antibiotics and measures to relieve discomfort. […] If you have severe pain in the scrotum, seek emergency treatment. If you have discharge from your penis or pain when you pass urine, see a health care provider. […] Causes of epididymitis include: STIs. Gonorrhea and chlamydia are the most common causes of epididymitis in young, sexually active males. […] To help protect against STIs that can cause epididymitis, practice safer sex. […] If you have recurrent urinary tract infections or other risk factors for epididymitis, your health care provider might talk with you about other ways you can help prevent the condition.

• #50 Epididymitis and Orchitis: An Overview | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0401/p583.html/1000

  Epididymitis and orchitis are commonly seen in the outpatient setting. Men between 14 and 35 years of age are most often affected, and Chlamydia trachomatis and Neisseria gonorrhoeae are the most common pathogens in this age group. […] Laboratory studies, including urethral Gram stain, urinalysis and culture, and polymerase chain reaction assay for C. trachomatis and N. gonorrhoeae, help guide therapy. […] Typical physical findings include a swollen, tender epididymis or testis located in the normal anatomic position with an intact ipsilateral cremasteric reflex. […] When epididymitis is suspected, polymerase chain reaction assays for C. trachomatis and N. gonorrhoeae should be performed on urethral swab or urine specimens. […] In addition to a careful history and physical examination, diagnostic studies can help confirm epididymitis and orchitis and detect the causative pathogen. […] A Gram stain and culture of swabbed urethral discharge are recommended to detect urethritis and gonococcal infection. […] If the diagnosis remains unclear, referral and surgical exploration of the scrotum is warranted.

• #51 Epididymitis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/epididymitis.htm

  All suspected cases of acute epididymitis should be evaluated for objective evidence of inflammation by one of the following POC tests: Gram, MB, or GV stain of urethral secretions demonstrating 2 WBCs per oil immersion field. […] All suspected cases of acute epididymitis should be tested for C. trachomatis and N. gonorrhoeae by NAAT. Urine is the preferred specimen for NAAT for men. […] Men should be instructed to return to their health care providers if their symptoms do not improve 72 hours after treatment. Signs and symptoms of epididymitis that do not subside in 3 days require reevaluation of the diagnosis and therapy.

• #52 Epididymitis Treatment | Symptoms & Diagnosis | CLS Health

  https://cls.health/conditions/epididymitis

  How to Diagnose Epididymitis? […] A thorough evaluation, including a physical exam and several diagnostic tests, is needed to confirm epididymitis and identify its cause. Diagnostic procedure options include: […] STI screening When sexually transmitted infections are suspected, healthcare providers may perform urethral swabs or blood tests to detect bacteria like chlamydia or gonorrhea. […] Ultrasound for epididymitis An ultrasound allows doctors to examine the scrotum for swelling, fluid buildup, or other abnormalities. It also helps differentiate epididymitis from conditions like testicular torsion. […] Urine and blood tests Urinalysis and blood tests provide valuable insights into infections or inflammation in the urinary and reproductive systems. These tests help confirm bacterial causes or rule out other possibilities.

• #53 Acute epididymitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/186

  Acute epididymitis is inflammation of the epididymis causing pain and swelling that develops over the course of a few days and lasts 6 weeks. […] Diagnostic tests include a Gram stain of urethral secretions, and urine specimens for nucleic acid amplification tests for C trachomatis, N gonorrhoeae, and M genitalium (where available). Urine microscopy and culture is also indicated if urinary pathogens are suspected. […] Key diagnostic factors include age 19 years, unilateral scrotal pain and swelling of gradual onset, symptoms 6 weeks’ duration, tenderness, hot, erythematous, swollen hemiscrotum, frequent and painful micturition, and purulent urethral discharge. […] 1st tests to order include Gram stain of urethral secretions, urine dipstick test, urine microscopy, urine culture, nucleic acid amplification test (NAAT) of urethral secretions or first-void urine for Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium.

• #54 Acute epididymitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-us/186?locale=ar&

  Acute epididymitis is inflammation of the epididymis causing pain and swelling that develops over the course of a few days and lasts 6 weeks. […] Diagnostic tests include a Gram stain of urethral secretions, and urine specimens for nucleic acid amplification tests for C trachomatis, N gonorrhoeae, and M genitalium (where available). Urine microscopy and culture is also indicated if urinary pathogens are suspected. […] Key diagnostic factors include presence of risk factors, age 19 years, unilateral scrotal pain and swelling of gradual onset, symptoms 6 weeks’ duration, tenderness, hot, erythematous, swollen hemiscrotum, frequent and painful micturition, and purulent urethral discharge. […] 1st investigations to order include Gram stain of urethral secretions, urine dipstick test, urine microscopy, urine culture, nucleic acid amplification test (NAAT) of urethral secretions or first-void urine for Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium.

• #55 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Epididymitis-Diagnosis.aspx

  The ultrasound imaging test is particularly useful in the differential diagnosis to rule out other conditions that require different treatments. […] It is important to make a differential diagnosis, as testicular torsion requires immediate medical attention with a surgical procedure. […] Epididymitis can be classified as acute or chronic, depending on the duration of symptoms.

• #56 Chronic epididymitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/chronic-epididymitis?lang=us

  Chronic epididymitis is a clinical diagnosis based on chronic epididymal pain lasting for at least six weeks. It is a common, possibly the most common, cause of scrotal pain. […] Patients present with chronic point tenderness of their epididymis +/- a palpable mass or swelling. […] Initial treatment consists of a trial of antibiotics as well as scrotal support, anti-inflammatories, and analgesia including nerve blocks. Chronic epididymitis is generally considered „self-limited” albeit with a chronic course; refractory cases may require surgical resection of the epididymis.

• #57 Acute epididymitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/186

  Acute epididymitis is inflammation of the epididymis causing pain and swelling that develops over the course of a few days and lasts 6 weeks. […] Diagnostic tests include a Gram stain of urethral secretions, and urine specimens for nucleic acid amplification tests for C trachomatis, N gonorrhoeae, and M genitalium (where available). Urine microscopy and culture is also indicated if urinary pathogens are suspected. […] Key diagnostic factors include age 19 years, unilateral scrotal pain and swelling of gradual onset, symptoms 6 weeks’ duration, tenderness, hot, erythematous, swollen hemiscrotum, frequent and painful micturition, and purulent urethral discharge. […] 1st tests to order include Gram stain of urethral secretions, urine dipstick test, urine microscopy, urine culture, nucleic acid amplification test (NAAT) of urethral secretions or first-void urine for Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium.

• #58 Acute Epididymitis: Practice Essentials, Diagnosis, Medical Care

  https://emedicine.medscape.com/article/777181-overview

  The Centers for Disease Control and Prevention (CDC) recommends using the following tests and findings to help diagnose acute epididymitis: […] In a study of 237 patients with acute epididymitis, a causative pathogen was identified in 132 antibiotic-naive patients and in 44 pretreated patients. The primary pathogen was Escherichia coli. Sexually transmitted infections were present in 34 cases (25 patients with C trachomatis). […] Ultrasonography is noninvasive and can help to differentiate epididymitis from testicular torsion. […] A study by Asgari et al suggests that C-reactive protein (CRP) levels and erythrocyte sedimentation rate (ESR) may be useful in differentiating epididymitis from testicular torsion. In this prospective study, investigators evaluated 120 patients with the diagnosis of acute scrotum; serum CRP and ESR were drawn at the time of admission. Of 46 patients with diagnosed epididymitis, 44 (95.6%) had elevation in CRP levels, and among 23 patients with torsion, 1 (4%) had an elevated CRP level.

• #59 Epididymitis

  https://www.nhs.uk/conditions/epididymitis/

  If you go to a GP or sexual health clinic with symptoms of epididymitis, you’ll usually need some tests first to find out the cause. […] These may include: a groin examination, a swab of the tube that carries pee out of the body (urethra) to test for infection, urine and blood tests, a rectal examination to check for problems with your prostate. […] The treatment for epididymitis is usually antibiotics. They’re given as injections or taken as tablets, or a combination of both. […] It’s important to finish the whole course of antibiotics, even if you start to feel better.

• #60 Diagnosis and management of epididymitis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/18061028/

  Epididymitis is a common and morbid condition seen across a wide age range. […] Although there have been multiple advances in imaging of the scrotum and detection of urinary pathogens, a large portion of cases remain idiopathic. […] Management of epididymitis is often difficult, but relies on clinical expertise and the use of established clinical guidelines.

• #61 Epididymitis and Orchitis: An Overview | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0401/p583.html/1000

  Epididymitis and orchitis are commonly seen in the outpatient setting. Men between 14 and 35 years of age are most often affected, and Chlamydia trachomatis and Neisseria gonorrhoeae are the most common pathogens in this age group. […] Laboratory studies, including urethral Gram stain, urinalysis and culture, and polymerase chain reaction assay for C. trachomatis and N. gonorrhoeae, help guide therapy. […] Typical physical findings include a swollen, tender epididymis or testis located in the normal anatomic position with an intact ipsilateral cremasteric reflex. […] When epididymitis is suspected, polymerase chain reaction assays for C. trachomatis and N. gonorrhoeae should be performed on urethral swab or urine specimens. […] In addition to a careful history and physical examination, diagnostic studies can help confirm epididymitis and orchitis and detect the causative pathogen. […] A Gram stain and culture of swabbed urethral discharge are recommended to detect urethritis and gonococcal infection. […] If the diagnosis remains unclear, referral and surgical exploration of the scrotum is warranted.

• #62 Epididymitis Workup: Approach Considerations, Laboratory Findings in Acute Epididymitis and Nonviral Orchitis, Ultrasonography

  https://emedicine.medscape.com/article/436154-workup

  Amiodarone plasma levels or antibodies are not helpful in the diagnosis of amiodarone-induced epididymitis. […] Use imaging studies to help distinguish acute epididymitis from the more ominous testicular torsion. However, clinical judgment must guide interpretation of imaging results, as they are neither 100% sensitive nor specific. […] Confirmatory imaging is unnecessary in a patient with a clear history consistent with epididymitis; ultrasonographic results are positive in only 69% of patients with clinical epididymitis. […] MRI has high sensitivity and specificity for testicular torsion and is useful for differentiating epididymitis and testicular torsion when ultrasound findings are inconclusive. […] Radiologic studies are recommended in children who have bacteruria and acute epididymitis in order to evaluate for structural abnormalities (found in 50% of these patients).

• #63 Epididymitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/epididymitis/symptoms-causes/syc-20363853

  Epididymitis is usually treated with antibiotics and measures to relieve discomfort. […] If you have severe pain in the scrotum, seek emergency treatment. If you have discharge from your penis or pain when you pass urine, see a health care provider. […] Causes of epididymitis include: STIs. Gonorrhea and chlamydia are the most common causes of epididymitis in young, sexually active males. […] To help protect against STIs that can cause epididymitis, practice safer sex. […] If you have recurrent urinary tract infections or other risk factors for epididymitis, your health care provider might talk with you about other ways you can help prevent the condition.

• #64

  https://www.aurorahealthcare.org/services/urology/epididymitis

  Epididymitis can be caused by various factors, including bacterial infections, sexually transmitted infections (STIs) or urinary tract infections (UTIs). […] Your provider will perform a physical exam to determine if you have epididymitis. They will review your medical history and examine your scrotum to check for tenderness or lumps. They may also do a rectal exam to check for enlargement of the prostate gland. […] Other tests your provider may use for an epididymitis diagnosis include: STI screening: This test involves inserting a narrow swab into the end of your penis to collect a sample of discharge to check for chlamydia and gonorrhea. Urine and blood tests: These tests are used to check for bacteria in the blood and urine. Ultrasound: A picture is taken of your testicle to rule out testicular torsion or check blood flow to the testicle.

• #65 Antibiotic Therapy for Epididymitis

  https://www.uspharmacist.com/article/antibiotic-therapy-for-epididymitis

  Patients presenting with symptoms consistent with epididymitis should undergo a thorough physical examination and laboratory testing to confirm the diagnosis and determine causative pathogens. Common laboratory tests include a CBC, urinalysis, urine culture, urethral culture, and Gram stain. […] An accurate social and medical history should be obtained to determine patient risk factors for specific causative pathogens. […] Sexually active men 35 years of age should be tested for C trachomatis and N gonorrhoeae by the nucleic acid amplification test (NAAT). […] If a fungal, mycobacterial, or enteric bacterial infection is suspected, a tissue aspirate or biopsy may be obtained for culture. […] Use of ultrasound in diagnosis should be limited to patients with scrotal pain who cannot be diagnosed by the methods previously discussed or when testicular torsion is suspected.

• #66 Epididymitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/17697-epididymitis

  Its important to talk to a healthcare provider as soon as you notice symptoms to get proper treatment and avoid further complications. […] Most people who get treatment for epididymitis start to feel better after about three days. […] If you dont, epididymitis may return and be harder to treat. […] If a healthcare provider diagnoses you with epididymitis, youll want to learn all you can about your outlook and treatment options.

• #67 Epididymitis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/epididymitis.htm

  All suspected cases of acute epididymitis should be evaluated for objective evidence of inflammation by one of the following POC tests: Gram, MB, or GV stain of urethral secretions demonstrating 2 WBCs per oil immersion field. […] All suspected cases of acute epididymitis should be tested for C. trachomatis and N. gonorrhoeae by NAAT. Urine is the preferred specimen for NAAT for men. […] Men should be instructed to return to their health care providers if their symptoms do not improve 72 hours after treatment. Signs and symptoms of epididymitis that do not subside in 3 days require reevaluation of the diagnosis and therapy.

• #68 STI-associated syndromes guide: Epididymitis – Canada.ca

  https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/sti-associated-syndromes/epididymitis.html

  Consider urgent consultation with an experienced colleague and hospitalization when severe pain or high fever suggests another diagnosis or complicated infection (testicular torsion, testicular infarction, abscess, necrotizing fasciitis). […] Evaluate response to treatment 48 hours after initiation. If there is no clinical improvement, reassess the diagnosis and treatment. […] When treatment is indicated for an STI: notify, evaluate, test and treat (as appropriate) sexual partners.

• #69 How to Know If You Have Epididymitis: Symptoms & Causes

  https://www.wikihow.com/Know-if-You-Have-Epididymitis

  Follow up with your doctor if you dont feel improvements in 3 days. Notice whether your symptoms begin disappearing after you start your antibiotics. If theres no relief within 72 hours, call or visit your doctor for a reevaluationits possible theres a stronger infection or another cause of symptoms that needs to be treated.

• #70 Epididymitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/17697-epididymitis

  Epididymitis is inflammation of your epididymis (ep-uh-DID-uh-miss) that causes discomfort or pain in your scrotum, testicle or epididymis. […] A healthcare provider will ask you questions about your symptoms and perform a physical examination of your scrotum to look for a tender area or lump. They may also order tests, including: […] Theyll look for the presence of bacteria in a sample of your pee. […] Theyll withdraw a sample of blood and examine it for signs of infection. […] Theyll insert a swab into your urethra and test the swab for STI pathogens (bacteria or viruses), which may require treatment. […] In some cases, they may take images of your scrotum to help make an epididymitis diagnosis. […] If bacteria cause epididymitis, treatment involves antibiotics. […] Most people need to take antibiotics for about one to two weeks.

• #71 Epididymitis: Causes (Etiology) and Treatment

  https://www.urology-textbook.com/epididymitis.html

  After obtaining a urethral swab and urine culture, calculated antibiotic therapy is started in adolescents and adults. […] The IUSTI guideline recommends a single dose of ceftriaxone 1 g i.m. combined with azithromycin 2 g p.o. in a single dose. […] Ciprofloxacin 500 mg 1-0-1 or other quinolones penetrate well into the epididymis and are prescribed for at least ten days. […] Epididymectomy: indicated in epididymitis refractory to antibiotic treatment or chronic epididymitis. […] Orchiectomy: indicated in epididymoorchitis, abscess formation, and epididymitis refractory to antibiotic treatment as an alternative to epididymectomy.

• #72 Epididymitis – Clinical Features – Management – TeachMeSurgery

  https://teachmesurgery.com/urology/genital-tract/epididymitis/

  Current EAU Guidelines suggest first line treatments of: Enteric organisms – Ofloxacin 200mg PO BD for 14 days or levofloxacin 500mg BD for 10 days; Sexually-transmitted organisms – Ceftriaxone 500mg IM single dose and Doxycycline 100mg PO twice daily for 10-14 days (with Azithromycin 1g PO single dose added if gonorrhoea likely). […] Diagnosis is clinical, however can be aided by ultrasound Doppler imaging.

• #73 Epididymitis

  https://www.nhs.uk/conditions/epididymitis/

  If you go to a GP or sexual health clinic with symptoms of epididymitis, you’ll usually need some tests first to find out the cause. […] These may include: a groin examination, a swab of the tube that carries pee out of the body (urethra) to test for infection, urine and blood tests, a rectal examination to check for problems with your prostate. […] The treatment for epididymitis is usually antibiotics. They’re given as injections or taken as tablets, or a combination of both. […] It’s important to finish the whole course of antibiotics, even if you start to feel better.

• #74 Epididymitis and Orchitis: Causes, Diagnosis & Treatment

  https://atlanticurologyclinics.com/conditions/epididymitis-and-orchitis/

  If a bacterial infection is the underlying cause of epididymitis or orchitis, antibiotics will be prescribed. The specific antibiotic depends on the bacterial species identified as the cause of the condition. […] Treatment is primarily symptomatic for viral orchitis, like that caused by mumps. In these cases, treatment involves the use of over-the-counter pain relievers, rest, and scrotal support while the body combats the viral infection. […] If left untreated, epididymitis and orchitis can lead to serious complications. These can include abscess formation, chronic pain, and, rarely, reduced fertility. Therefore, early diagnosis and prompt treatment are essential.

• #75 Epididymitis and Epididymo-orchitis – Men’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/men-s-health-issues/penile-and-testicular-disorders/epididymitis-and-epididymo-orchitis

  Epididymitis and epididymo-orchitis are diagnosed by physical examination, urinalysis, and sometimes Doppler ultrasonography. […] Epididymitis and epididymo-orchitis are diagnosed by physical examination and urinalysis. Doppler ultrasonography is sometimes used to assess blood flow to the testes. […] If a sexually transmitted infection is the suspected cause, the doctor may take a urethral swab to test for gonorrhea and chlamydia.

• #76 Epididymitis: An Overview | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/1101/p723.html

  Inflammation of the epididymis, or epididymitis, is commonly seen in the outpatient setting. Epididymitis presents as the gradual onset of posterior scrotal pain that may be accompanied by urinary symptoms such as dysuria and urinary frequency. Physical findings include a swollen and tender epididymis with the testis in an anatomically normal position. […] Acute epididymitis generally presents as the gradual onset of posterior scrotal pain and swelling over one to two days. There may be concurrent symptoms of fever, hematuria, dysuria, and urinary frequency, and the pain may radiate into the lower abdomen. […] Acute epididymitis is a clinical diagnosis. A midstream urinalysis should be obtained to evaluate for an infectious cause. A urine culture should be obtained for all children, and for adults with a positive urinalysis result.

• #77 Epididymitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/epididymitis/

  Epididymitis is a clinical diagnosis, with patients typically presenting with a gradual onset of pain and swelling of the affected scrotum and a positive Prehn sign. […] Urinalysis and testing for sexually transmitted infections (STIs) can help confirm the diagnosis. […] Epididymitis is a clinical diagnosis. […] Urine and urethral studies help tailor antibiotic therapy and identify the causative organism. […] Imaging is primarily used to rule out testicular torsion but can confirm epididymitis if the diagnosis is uncertain. […] Testing for HIV and syphilis is recommended for all patients with acute epididymitis. […] Duplex ultrasound of the scrotum may be used to rule out testicular torsion and scrotal abscess. […] Findings: An enlarged, hyperemic epididymis with increased blood flow indicates epididymitis.

• #78 Epididymitis and Orchitis: Causes, Diagnosis & Treatment

  https://atlanticurologyclinics.com/conditions/epididymitis-and-orchitis/

  There are multiple steps in diagnosing epididymitis and orchitis. The first step is a detailed discussion of symptoms, their duration and severity, and any potential exposure to risk factors, such as sexually transmitted infections or urinary tract abnormalities. […] Then, the physician will perform a physical examination. Testicles and the area of the epididymis will be examined to look for signs of swelling, redness, and tenderness. The doctor may feel for enlarged lymph nodes in the groin. The penis may be inspected to identify abnormal discharge. […] Determining if epididymitis or orchitis is present and what may be causing the condition often includes several laboratory tests, including: […] Urinalysis involves testing a urine sample for signs of infection, such as the presence of white blood cells or bacteria. A urine culture may also be performed to identify the specific type of bacteria causing the infection.

• #79 Epididymitis and Orchitis: Causes, Diagnosis & Treatment

  https://atlanticurologyclinics.com/conditions/epididymitis-and-orchitis/

  These tests identify sexually transmitted infections such as gonorrhea and chlamydia. A sample for NAATs can be collected through a urine sample or a swab inside the penis. […] In some instances, blood tests might be needed to check for signs of infection elsewhere in the body or to exclude other potential causes of symptoms. […] Imaging tests, like those listed below, provide a detailed view of the scrotum and its structures. […] This painless test uses sound waves to produce images of the structures within the scrotum. It helps determine whether there is inflammation in the epididymis or testicle. It can also exclude other conditions, such as testicular torsion. […] Treatment strategies for epididymitis and orchitis aim to alleviate symptoms, eradicate the infection, and prevent potential complications. The exact treatment plan may differ based on several factors, including the cause of the condition and the severity of symptoms.

• #80 Epididymitis and Orchitis: An Overview | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0401/p583.html/1000

  Epididymitis and orchitis are commonly seen in the outpatient setting. Men between 14 and 35 years of age are most often affected, and Chlamydia trachomatis and Neisseria gonorrhoeae are the most common pathogens in this age group. […] Laboratory studies, including urethral Gram stain, urinalysis and culture, and polymerase chain reaction assay for C. trachomatis and N. gonorrhoeae, help guide therapy. […] Typical physical findings include a swollen, tender epididymis or testis located in the normal anatomic position with an intact ipsilateral cremasteric reflex. […] When epididymitis is suspected, polymerase chain reaction assays for C. trachomatis and N. gonorrhoeae should be performed on urethral swab or urine specimens. […] In addition to a careful history and physical examination, diagnostic studies can help confirm epididymitis and orchitis and detect the causative pathogen. […] A Gram stain and culture of swabbed urethral discharge are recommended to detect urethritis and gonococcal infection. […] If the diagnosis remains unclear, referral and surgical exploration of the scrotum is warranted.

• #81 Epididymo-orchitis | STI Guidelines Australia

  https://sti.guidelines.org.au/syndromes/epididymo-orchitis/

  Epididymo-orchitis is inflammation of the epididymis, and occasionally the testis. […] Non-STI causes for epididymo-orchitis are possible in the presence of a urinary tract infection or prostatitis. […] Infections are diagnosed through various tests including NAAT for Chlamydia and Gonorrhoea, and microscopy, culture, and sensitivities for urinary pathogens. […] If diagnosis remains uncertain and pain is severe, refer for urgent surgical assessment. Torsion can result in the loss of the testis within hours. […] If STI-related, all sexual partners from the past 6 months should be tested and treated. […] Follow-up at 4-5 days provides an opportunity to assess treatment response and reassess in light of the test results, including antibiotic sensitivities.

• #82 Epididymitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/17697-epididymitis

  Its important to talk to a healthcare provider as soon as you notice symptoms to get proper treatment and avoid further complications. […] Most people who get treatment for epididymitis start to feel better after about three days. […] If you dont, epididymitis may return and be harder to treat. […] If a healthcare provider diagnoses you with epididymitis, youll want to learn all you can about your outlook and treatment options.

• #83 Epididymitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430814/

  The differential diagnoses of epididymitis include but are not limited to the following: Epididymal congestion following vasectomy, Hydrocele, Orchitis, Referred or radicular pain, Scrotal trauma, Spermatocele, Testicular trauma, Testicular seminoma, Tunica vaginalis tumor, Urinary tract infection. […] Epididymitis is a frequent presentation to the emergency department. However, the diagnosis can often be confused with testicular torsion, which is a surgical emergency. […] The outcomes for most men with epididymitis are excellent, but relapses may occur in patients who are not compliant with therapy.

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