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''' '''with E. coli as the most common organism'''.
****'''<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:''' '''ofloxacin 200 mg PO BID x 14 days''' or levofloxacin
**'''<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