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Acute Epididymorchitis

Clinical Evaluation of Testicular Pain

History. Epididymitis is indicated by a unilateral painful testicle and a history of unprotected intercourse, new sexual partner, urinary tract infection, dysuria, or discharge. Symptoms may occur following acute lifting or straining epididimitis.

Physical. The epididymis and testicle are painful, swollen, and tender; scrotum may be erythematosus and warm with associated spermatic cord thickening or penile discharge.

Differential Diagnosis of Painful Scrotal Swelling

Epididymitis, testicular torsion, testicular cancer, hernia.

Torsion is characterized by sudden onset, age <20, elevated testicle, previous scrotal pain. The epididymis will be located anteriorly on either side and there is an absence of evidence of urethritis and UTI.

Epididymitis is favored by fever, laboratory evidence of urethritis or cystitis, and increased scrotal warmth.

Laboratory Evaluation

Epididymorchitis is indicated by leukocytosis (left shift); UA shows pyuria and bacteriuria.

Midstream urine culture will reveal gram negative bacilli. Chlamydia and Neisseria cultures should be taken, although they are often unsuccessful. Epididymal aspirate may be indicated if there is a poor treatment response or recurrent infection.

Common Pathogens

Younger Men. It is usually

Treatment of Epididymitis

Bed rest during acute phase; scrotal elevation with