Epididymitis

Last updated: November 23, 2021

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Epididymitis is the inflammation of the epididymis and is commonly associated with genitourinary tract infections. 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. Testicular torsion is the most important differential diagnosis of epididymitis; if it cannot be ruled out clinically, an urgent ultrasound must be performed. The treatment for epididymitis includes empiric antibiotic therapy based on the most likely source of infection and symptomatic management, e.g., scrotal elevation and NSAIDs.

The following recommendations are consistent with the 2021 CDC STI guidelines. [2]

General principles

Testicular torsion is the most important differential diagnosis of epididymitis and must be ruled out first! Consult urology if the diagnosis remains unclear.

Routine laboratory studies [2][3][4]

Testing for HIV and syphilis is recommended for all patients with acute epididymitis. [2]

Additional laboratory studies

Not usually indicated

Duplex ultrasound of the scrotum [2]

The differential diagnoses listed here are not exhaustive.

The following recommendations apply to acute epididymitis and are consistent with the 2021 CDC STI guidelines. Consult urology regarding the management of chronic epididymitis. [2][6]

Antibiotic treatment

If an STI is suspected, patients should abstain from sex until they and any partners have been successfully treated. Refer all sexual partners from the previous 60 days before symptom onset for evaluation, testing, and presumptive treatment. [2]

Symptomatic management

Indicated for all patients as needed

  • Scrotal elevation
  • NSAIDs
  • Avoidance of aggravating activities
  • Application of a cold pack

Surgical intervention

Disposition [2]

  • Outpatient management is usually sufficient for patients with acute epididymitis.
  • Consider inpatient treatment and/or consult urology:

We list the most important complications. The selection is not exhaustive.

  1. Ludwig M. Diagnosis and therapy of acute prostatitis, epididymitis and orchitis. Andrologia. 2008; 40 (2): p.76-80.
  2. Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR. Recommendations and Reports. 2021; 70 (4): p.1-187. doi: 10.15585/mmwr.rr7004a1 . | Open in Read by QxMD
  3. Taylor SN. Epididymitis. Clin Inf Dis. 2015; 61 (suppl 8): p.S770-S773. doi: 10.1093/cid/civ812 . | Open in Read by QxMD
  4. McConaghy JR, Panchal B. Epididymitis: An Overview.. Am Fam Physician. 2016; 94 (9): p.723-726.
  5. Crawford P, Crop JA. Evaluation of scrotal masses.. Am Fam Physician. 2014; 89 (9): p.723-7.
  6. Nickel JC. Chronic epididymitis: a practical approach to understanding and managing a difficult urologic enigma.. Rev Urol. 2003; 5 (4): p.209-15.
  7. Trojian TH, Lishnak TS, Heiman D. Epididymitis and orchitis: An overview. Am Fam Physician. 2009; 79 (7): p.583-587.

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