ACUTE EPIDIDYMITIS & EPIDYMO-ORCHITIS
Acute epididymitis is the most common cause of scrotal pain in adults.
Acute epididymitis is most commonly infectious in etiology but can also be from noninfectious causes such as trauma and autoimmune diseases.N. gonorrhoeae and C. trachomatis are the most common organisms responsible for acute epididymitis in men under the age of 35.
The clinical features of acute epididymitis include localized testicular pain with tenderness and swelling on palpation of the affected epididymis, which is located posteriorly on the testis .
Management of acute epididymitis varies according to its severity . Most cases can be treated on an outpatient basis with oral antibiotics, nonsteroidal antiinflammatory drugs (NSAIDs), local application of ice, and scrotal elevation. Acutely ill patients may warrant hospitalization for parenteral antibiotics and intravenous hydration.
●Patients under the age of 35 or who are at risk of sexually transmitted infections (eg, sex outside of monogamous relationship) – We suggest coverage for N. gonorrhoeae and C. trachomatis with ceftriaxone (250 mg intramuscular injection in one dose) plus doxycycline (100 mg orally twice a day for 10 days). For patients unable to tolerate doxycycline, azithromycin (1 g orally in one dose) is an alternative option.
●Patients 35 years of age or older and who are at low risk for sexually transmitted infections – We suggest coverage for enteric pathogens with levofloxacin 500 mg orally once daily for 10 days or ofloxacin 300 mg orally twice a day for 10 days.
●Patients of any age who practice insertive anal intercourse – We suggest coverage for N. gonorrhoeae, C. trachomatis, and enteric pathogen infections with ceftriaxone (250 mg intramuscular injection in one dose) plus a fluoroquinolone (levofloxacin 500 mg orally once daily for 10 days or ofloxacin 300 mg orally twice a day for 10 days).
DR ATUL CHOWDHURY Ex CMO
Presently senior Consultant at Max Hospital , Dehradun.
Central Reserve Police Force