Editing Infections: Orchitis, & Epididymitis (section)

==Epididymitis==
===Definitions===
*Epididymitis: inflammation of the epididymis
*'''<span style="color:#ff0000">Acute epididymitis: sudden occurrence of pain and swelling of the epididymis associated with acute inflammation of the epididymis that lasts < 6 weeks</span>'''
*'''<span style="color:#ff0000">Chronic epididymitis: inflammation and pain in the epididymis, usually without swelling (but with induration in long-standing cases), persisting > 6 weeks</span>'''
**'''<span style="color:#ff0000">Chronic infectious epididymitis is most commonly seen with tuberculosis,</span>''' as a consequence of hematogenous spread rather than seeding of the urinary tract from the kidneys
===Classification===
#'''Acute bacterial epididymitis'''
#*Secondary to UTI or sexually transmitted disease
#'''Non-bacterial infectious epididymitis'''
#*Viral
#*Fungal
#*Parasitic
#'''Non-infectious epididymitis'''
#*Idiopathic
#*Traumatic
#*Autoimmune
#*'''Amiodarone-induced'''
#*Associated with a known syndrome (e.g., Behçet disease)
#'''Chronic epididymitis'''
#'''Chronic epididymalgia'''
===Causes===
*'''Acute epididymitis''' 
**'''Usually results from the spread of infection from the bladder, urethra, or prostate via the ejaculatory ducts and vas deferens into the epididymis.'''
**'''<span style="color:#ff0000">Source of infection and pathogen depends on population</span>'''
***'''<span style="color:#ff0000">In elderly males</span>'''
****'''<span style="color:#ff0000">Most common causes (3)</span>'''
****#'''<span style="color:#ff0000">BPH and associated stasis</span>'''
****#'''<span style="color:#ff0000">Urinary tract infection</span>'''
****#'''<span style="color:#ff0000">Catheterization</span>'''
****'''<span style="color:#ff0000">Most common pathogen in the pediatric and elderly age groups are the uropathogens </span>with E. coli as the most common organism'''.
***'''<span style="color:#ff0000">In sexually active males younger age < 35 who have sex with females</span>'''
****'''<span style="color:#ff0000">Commonly caused by sexually transmitted infection</span>'''
****'''<span style="color:#ff0000">Common pathogens: N. gonorrhoeae and C. trachomatis</span>'''
***'''<span style="color:#ff0000">Among males who have sex with males (MSM)</span>'''
****'''<span style="color:#ff0000">Can result from anal intercourse</span>'''
****'''<span style="color:#ff0000">Common pathogens: E. coli and Pseudomonas</span>'''
*'''<span style="color:#ff0000">Chronic epididymitis (5)</span>'''
*#'''<span style="color:#ff0000">Inadequately treated acute epididymitis</span>'''
*#'''<span style="color:#ff0000">Recurrent epididymitis</span>'''
*#'''<span style="color:#ff0000">Tuberculosis</span>'''
*#'''<span style="color:#ff0000">Treatment with amiodarone</span>'''
*#'''<span style="color:#ff0000">Behçet disease</span>'''
*'''Recurrent epididymitis'''
**'''Risk factors (4)'''
**#'''Meatal stenosis'''
**#'''Urethral stricture'''
**#'''Voiding dysfunction (high pressure voiding)'''
**#'''Ectopic ureter'''
===Diagnosis and Evaluation===
*Must rule out testicular torsion, especially in younger patients
*'''History and Physical Exam'''
**'''Physical Examination''' 
***'''Localizes the tenderness to the epididymis.''' However, in many cases the testis is also involved in the inflammatory process and subsequent pain; this is referred to as epididymo-orchitis. The spermatic cord is usually tender and swollen.
*'''Labs'''
**'''Midstream urine specimen'''
**'''Gram staining of a urethral smear'''
*'''Imaging'''
**'''Scrotal ultrasonography''' 
***can be helpful but is not always diagnostic
*Insert figure
===Management===
*'''Empirical therapy is indicated before laboratory test results are available'''
**'''Anti-inflammatory agents, analgesics, scrotal support, and nerve blocks have all been recommended as empirical treatment'''
*'''<span style="color:#ff0000">Acute bacterial epididymitis</span>'''
**'''<span style="color:#ff0000">[https://uroweb.org/guidelines/urological-infections/chapter/the-guideline EAU Guidelines on Urological Infections]</span>'''
***'''<span style="color:#ff0000">If gonorrhea likely: ceftriaxone 1000mg IM/IV x 1 + doxycycline 200 mg initial dose by mouth and then 100 mg twice daily for ten to fourteen days</span>'''
***'''<span style="color:#ff0000">If gonorrhea unlikely (no urethral discharge): Doxycycline 200 mg initial dose by mouth and then 100 mg BID x 10-14 days plus an antibiotic active against ''Enterobacterales'' x 10-14 days</span>'''
***'''<span style="color:#ff0000">If non-sexually active: fluoroquinolone (levofloxacin) PO daily x 10-14 days</span>'''
*'''<span style="color:#ff0000">Chronic epididymitis</span>'''
**'''<span style="color:#ff0000">4- to 6-week trial of antibiotics that would potentially be effective against possible bacterial pathogens and particularly C. trachomatis may be appropriate.</span>'''
*'''Surgical removal of the epididymis (epididymectomy) should be considered only when all conservative measures have been exhausted''' and the patient accepts that the operation will have at best a 50% chance of curing his pain