Epididymitis

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
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