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Epididymitis

Epididymitis is a medical condition where the epididymis becomes inflamed. This condition may be mildly or very painful. Antibiotics may be needed to control a component of infection. more...

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Diagnosis

Epididymitis can be hard to distinguish from testicular torsion. Sometimes, both can occur at the same time. Tests are needed to distinguish chronic epididymitis from a range of other disorders that can cause constant scrotal pain. These include: testicular cancer, enlarged scrotal veins (varicocele) or a cyst within the epididymis. As well, the nerves in the scrotal area are connected to those of the abdomen, sometimes causing pain similar to a hernia (see referred pain). Tests may also include a physical examination and ultrasound. A urologist may need to be consulted.

Chronic epididymitis is epididymitis which lasts past the first treatment. Typically, a second, longer round of treatment is used. Chronic epididymitis is characterised by inflammation even when there is no infection present. This condition can develop even without the presence of the previously described known causes. It is believed that the hypersensitivity of certain structures, including nerves and muscles, may cause or contribute to chronic epididymitis. As a last resort, surgery may be employed.

Complications

Untreated, acute epididymitis can lead to a variety of complications. These include: chronic epididymitis, abscess, permanent damage or even destruction of the epididymis and testicle (resulting in infertility and/or hypogonadism), and infection may spread to any other organ or system of the body.

Treatment

Treatment options include: antibiotics, elevation of the scrotum, cold compresses applied regularly to the scrotum, hospitalisation in severe cases, check-ups to ensure the infection has cleared up. Pain is frequently so severe as to require opiate analgesics such as hydrocodone.

Epidemiology

This is usually caused by a secondary bacterial infection that is brought about by a variety of underlying conditions. Some cases of epididymitis are characterised by inflammation even when there is no infection. Urinary tract infections are the most common cause. The bacteria in the urethra back-track through the urinary and reproductive structures to the epididymis. It can also be caused by genito-urinary surgery, including prostatectomy, urinary catheterization, congenital kidney and bladder problems, and STDs, like gonorrhoea and chlamydia.

Acute epidiymitis has a tendency to spontaneously recur months or years after a successfully treated case.

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Assessing and treating epididymitis
From Nurse Practitioner, 3/1/01 by DuFour, Joseph L

Epididymitis accounts for more than 600,000 yearly U.S. health care visits.1 Acute epididymitis, which primarily affects adults, is defined as an inflamed epididymis that is tender and swollen and may be difficult to distinguish from the testes. The scrotum may be reddened and the vas deferens may also be inflamed. A coexisting urinary tract infection or prostatitis supports an epididymitis diagnosis.2

* Physical Examination

Objective evaluation and physical assessment of the genitalia are crucial in differentiating the diagnosis of epididymitis. The scrotum and penis are observed for scrotal swelling, scrotal erythema, and urethral discharge. Palpation of the affected testicle produces pain on the top and posterior area. Swelling may exist along the epididymis structure; this is anatomically positioned on the top and along the posterior surface of the testicle. Each testicle is thoroughly palpated.

The transillumination technique is then utilized to detect scrotal masses. This technique helps distinguish between solid and cystic lesions.3

The Prehn's sign is used to help differentiate the scrotal pain by elevating the testicle, which usually relieves the epididymitis discomfort;3 however, in testicular torsion, there is no change in discomfort.4 Pain relief may also be offered to the supine patient by elevating the scrotum above the pubic symphysis.3

A digital rectal examination is then performed as this can elicit any prostatic tenderness and urethral discharge. Discharge can then be cultured and analyzed.5

Lastly, a urinalysis is obtained for microscopic analysis. Urinalysis testing demonstrates pyuria in 20% to 95% of epididymitis cases.5

* Differential Diagnosis

Multiple testicular and genital disorders must be considered for the differential diagnosis: testicular torsion, testicular cancer, mumps orchitis, spermatocele, varicocele, hydrocele, and an epididymal cyst.6

* Treatnent

Primary treatment of epididymitis includes antibiotic therapy. Sexually transmitted infections are treated with 10 to 21 days of antibiotics; the sexual partner must be treated as well. If evidence of an underlying bacterial prostatitis exists, the antimicrobial therapy should be continued for 4 weeks.5

The U.S. Department of Health and Human Services states that empiric therapy is indicated before culture results become available. The recommended antibiotic regimens for sexually transmitted epididymitis caused by Chlamydia trachomatis and Neisseria gonorrhoeae include ceftriaxone sodium 250 mg LM. in a single dose and doxycycline 100 mg b.i.d. for 10 days. Any sexual partners within the past 60 days should also receive this treatment course. An alternative plan for cephalosporin- and tetracycline-- allergic patients includes ofloxacin 300 mg PO b.i.d. for 10 days (see Table).7

Symptomatic relief measures may be employed to decrease scrotal and genital pain: bed rest during the acute phase; scrotal support; ice pack to the scrotum; analgesics, including non, steroidal anti-inflammatory drugs; and a follow-up visit in 3 to 4 days if there is no improvement. Patient counseling is necessary to prevent future reinfection and intrascrotal complications.3,5-7

REFERENCES

1. Kaler SR: Epididymitis in the young adult male. Nurs Pract 1990;15(5):10-16.

2. Bates B: A guide to physical examination and history taking, 7th edition. Philadelphia, Pa.: Lippincott Williams & Wilkins, 1999;401.

3. Tierney LM, McPhee SJ, Papadakis MA: Current medical diagnosis and treatment, 38th edition. Stamford, Conn.: Appleton & Lange, 1999;902-06.

4. Tonetti JA, Tonetti FW: Testicular torsion or acute epididymitis? Diagnosis and treatment. J Emerg Nurs 1990;16(2):96-98.

5. Uphold CR, Graham MV Clinical guidelines in family practice, 3rd edition. Gainesville, Fla.: Barmarrae Books, Inc., 1998;617-20.

6. Dambro MR: Griffith's 5-minute clinical consult. Baltimore, Md.: Williams & Wilkins, 1998:366-67.

7. Centers for Disease Control and Prevention: U.S. Department of Health and Human Services: MMWR 1998;47(RR-1):86-88.

ABOUT THE AUTHOR

Joseph L DuFour, RN, CS, FNP, MS, is a lecturer, State University of New York, New Paltz.

Copyright Springhouse Corporation Mar 2001
Provided by ProQuest Information and Learning Company. All rights Reserved

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