Infections: Orchitis, & Epididymitis: Difference between revisions
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*'''Acute epididymitis''' | *'''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.''' | **'''Usually results from the spread of infection from the bladder, urethra, or prostate via the ejaculatory ducts and vas deferens into the epididymis.''' | ||
**'''Source of infection and pathogen depends on population''' | **'''<span style="color:#ff0000">Source of infection and pathogen depends on population</span>''' | ||
***'''In elderly males''' | ***'''<span style="color:#ff0000">In elderly males</span>''' | ||
****'''Most common causes (3)''' | ****'''<span style="color:#ff0000">Most common causes (3)</span>''' | ||
****#'''BPH and associated stasis''' | ****#'''<span style="color:#ff0000">BPH and associated stasis</span>''' | ||
****#'''Urinary tract infection''' | ****#'''<span style="color:#ff0000">Urinary tract infection</span>''' | ||
****#'''Catheterization''' | ****#'''<span style="color:#ff0000">Catheterization</span>''' | ||
****'''Most common pathogen in the pediatric and elderly age groups are the uropathogens | ****'''<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'''. | ||
***'''In sexually active males younger age < 35 who have sex with females''' | ***'''<span style="color:#ff0000">In sexually active males younger age < 35 who have sex with females</span>''' | ||
****'''Commonly caused by sexually transmitted infection''' | ****'''<span style="color:#ff0000">Commonly caused by sexually transmitted infection</span>''' | ||
****'''Common pathogens: N. gonorrhoeae and C. trachomatis''' | ****'''<span style="color:#ff0000">Common pathogens: N. gonorrhoeae and C. trachomatis</span>''' | ||
***'''Among males who have sex with males (MSM)''' | ***'''<span style="color:#ff0000">Among males who have sex with males (MSM)</span>''' | ||
****'''Can result from anal intercourse''' | ****'''<span style="color:#ff0000">Can result from anal intercourse</span>''' | ||
****'''Common pathogens: E. coli and Pseudomonas''' | ****'''<span style="color:#ff0000">Common pathogens: E. coli and Pseudomonas</span>''' | ||
*'''Chronic epididymitis (5)''' | *'''<span style="color:#ff0000">Chronic epididymitis (5)</span>''' | ||
*#'''Inadequately treated acute epididymitis''' | *#'''<span style="color:#ff0000">Inadequately treated acute epididymitis</span>''' | ||
*#'''Recurrent epididymitis''' | *#'''<span style="color:#ff0000">Recurrent epididymitis</span>''' | ||
*#'''Tuberculosis''' | *#'''<span style="color:#ff0000">Tuberculosis</span>''' | ||
*#'''Treatment with amiodarone''' | *#'''<span style="color:#ff0000">Treatment with amiodarone</span>''' | ||
*#'''Behçet disease''' | *#'''<span style="color:#ff0000">Behçet disease</span>''' | ||
===Diagnosis and Evaluation=== | ===Diagnosis and Evaluation=== | ||
*Must rule out testicular torsion, especially in younger patients | *Must rule out testicular torsion, especially in younger patients | ||
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*'''Empirical therapy is indicated before laboratory test results are available''' | *'''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''' | **'''Anti-inflammatory agents, analgesics, scrotal support, and nerve blocks have all been recommended as empirical treatment''' | ||
*'''Acute bacterial epididymitis''' | *'''<span style="color:#ff0000">Acute bacterial epididymitis</span>''' | ||
**'''Men age < 35: ceftriaxone 250 mg IM x1 + doxycycline 100 mg PO BID x 10-14 days''' (azithromycin 1g PO x 1 could be used instead of doxycycline) | **'''<span style="color:#ff0000">Men age < 35: ceftriaxone 250 mg IM x1 + doxycycline 100 mg PO BID x 10-14 days</span>''' (azithromycin 1g PO x 1 could be used instead of doxycycline) | ||
**'''Men age > 35: | **'''<span style="color:#ff0000">Men age > 35: ofloxacin 200 mg PO BID x 14 days </span>or levofloxacin | ||
**'''If concerned for both STI and enteric organisms, then ceftriaxone 250 mg IM x1 + ofloxacin 200 mg PO BID x 14 days''' | **'''If concerned for both STI and enteric organisms, then ceftriaxone 250 mg IM x1 + ofloxacin 200 mg PO BID x 14 days''' | ||
*'''Chronic epididymitis''' | *'''<span style="color:#ff0000">Chronic epididymitis</span>''' | ||
**'''4- to 6-week trial of antibiotics that would potentially be effective against possible bacterial pathogens and particularly C. trachomatis may be appropriate.''' | **'''<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 | *'''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 | ||