Epididymitis is inflammation of the epididymis, the coiled tube behind the testis, usually from infection. In sexually active men under 35 the main causes are chlamydia and gonorrhea, while in older men urinary bacteria such as E. coli are more common.
Key symptoms
- Scrotal pain that builds over hours to days
- Swelling and redness of one side of the scrotum
- Burning urination or urethral discharge
- Fever in some patients
What you find on exam
- Tender, swollen epididymis behind the testis
- Pain may ease when the testis is lifted (Prehn sign)
- Normal cremasteric reflex, which argues against torsion
- Check for urethral discharge and inguinal hernia
Tests
- Urinalysis and urine culture
- NAAT for chlamydia and gonorrhea
- Scrotal Doppler ultrasound: more blood flow, rules out torsion
- HIV and syphilis testing when an STI is suspected
Treatment basics
- STI risk: single dose of ceftriaxone plus doxycycline for 10 days
- Urinary bacteria likely: levofloxacin for 10 days
- Rest, scrotal support, ice and NSAIDs
- Treat partners and avoid sex until treatment is finished
Red flags
- Sudden severe pain with absent cremasteric reflex (testicular torsion)
- Fever with a fluctuant mass (abscess)
- Sepsis or no improvement after 72 hours
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.