Clinical Information on Epididymitis

diagnostic criteria

• Pain in the scrotum and palpable swelling and tenderness of the epididymis
• Possibly. ultrasound examination can confirm the diagnosis

Differential

• Testicular torsion (funikeltorsion) – more acute onset of symptoms
• tumor testis
• Layer from external genitalia
• orchitis
• Varicocele – no soreness

Medical history

• Slow onset of heaviness and pain in the scrotum, rays often up in the abdomen
• Chills, temperature increase to 39-40 ° C, swelling and tenderness at one epididymis
• At the same time burning and frequent urination, sometimes discharge

clinical findings

• Swelling, redness and local heat, usually unilateral
• Palpation of the epididymis, dorsal and cranial to the testicle, and funiklen is very painful
• Fever occurs frequently, there may be malaise
• At the same time cystit- or uretrit symptoms occur
• Prehns characters: by lifting the scrotum pain relief is obtained by epididymitis, while this will not lead to relief by testicular torsion

Additional studies in general practice

• Inoculation of the urethra in order to chlamydia and gonorrhea
• In men over 35 years: midstream urine to stixundersøgelse and cultivation
• Blood tests provide little additional information
  • CRP , and leucocytes SR may be elevated

other studies

• Ultrasound examination to substantiate the diagnosis, especially if you are unsure whether there is abscess formation, or any. funikeltorsion
• Urography and cystoscopy is only indicated for suspected underlying urinary tract disease

When to refer the patient?

• At high fever and malaise patient should be admitted to hospital
• If testicular torsion or cancer can not be excluded

Treatment goals

• The elimination of the infection

Generally about the treatment

• Antibiotics and ro

What can the patient do?

• Bed rest and analgesics will relieve the first days
• Possibly. suspensorium which stabilizes the testicles

Medical treatment

• Men under 35 – or suspected sexually transmitted disease in men over 35 years are treated as sexually transmitted disease:
  • Azithromycin  1 g as engangsdose or 500 mg a day for 3 days
  • Doxycycline  100 mg x 2 for 7 days is an alternative
• Men over 35-40 years
  • Ampicillin  500mg x 3 for 2 weeks – or
  • Mecillinam  400mg x 3 for 2 weeks –
  • Ciprofloxacin 500 mg x 2 for 10-14 days
• Appendix with NSAIDs has been reported to be effective

Progress

• The condition develops slowly. The patient can after the acute phase having swelling in the scrotum for weeks to months

complications

• Cyst formation in the epididymis
• sterility

Forecast

• Possibility of sterility is present
• From time to develop cysts in the epididymis

What are the written patient information

• Information about epididymitis
• About antibiotics

Level

• The patient should be checked after one month
• By not sexually transmitted disease and lack of response to treatment, urological investigation topical
• If palpationsfundet not quite normal, it is ordered ultrasound examination of the scrotum / testicles

What should be checked

• Bacteriological investigation after evidence sexually transmissible disease
• Treatment and follow-up of potential partners
• Exclude underlying testicular