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Chlamydia Trachomatis Infection Mimicking Testicular Malignancy In 270 Sex Transm Inf 1999;75:270 Chlamydia trachomatis infection mimicking Sex Transm Infect: first published as 10.1136/sti.75.4.270 on 1 August 1999. Downloaded from Case report: testicular malignancy in a young man cobblestone A M Ward, J H Rogers, C S Estcourt A young man with a low risk history for sexually transmitted diseases presented with an appar- ently longstanding, previously asymptomatic scrotal mass, highly suggestive of testicular malignancy on palpation. Ultrasound sited the lesion in the epididymis. Although there was no evidence of urethritis, chlamydia polymerase chain reaction testing was positive. Tumour mark- ers were negative. Complete clinical and radiological response was achieved after a long course of doxycycline treatment, without surgical exploration of the scrotum, confirming the diagnosis of chlamydial epididymitis. (Sex Transm Inf 1999;75:270) Keywords: testicular malignancy; Chlamydia trachomatis; epididymitis A 36 year old Chinese man presented with a 2 Fifteen months later the patient was asymp- day history of a sore scrotal lump. He had no tomatic with normal examination and ultra- urethral discharge or dysuria, and no history of sonography, and negative urinary chlamydia sexually transmitted diseases. He denied any PCR. He declined semen analysis. extramarital sexual partners since his marriage 5 years ago, but acknowledged four or five female partners before that. The couple had one child and were using condoms for contra- Discussion ception. Longstanding, subacute epididymitis, present- Examination revealed left sided scrotal ing with a painless scrotal mass, and without swelling and a mildly tender mass, inseparable evidence of urethritis, is an unusual complica- from the lower pole of the left testis, with an tion of chlamydial infection.1 irregular surface and rock hard consistency. It Two cases of orchidectomy for presumptive did not transilluminate. There was no meatal cancer, in which the final diagnosis was discharge and no polymorphs on Gram stain of epididymitis, have been reported.23One report a urethral swab. An STD screen was per- described a case of chlamydial epididymitis in a http://sti.bmj.com/ formed. Trimethoprim was prescribed for a 29 year old man, diagnosed by PCR on provisional diagnosis of non-sexually transmit- testicular tissue, after unilateral orchidectomy ted epididymitis secondary to a testicular for a scrotal mass inseparable from the testis at Sydney Sexual Health tumour. Centre, Sydney surgical exploration. Contralateral epididymi- Hospital, Sydney, Urgent scrotal ultrasound revealed a 23 mm tis ensued 2 weeks later, responding to doxycy- NSW, Australia mass with a ragged margin and increased cline treatment. AMWard vascularity, located in the tail of the left Cases such as these indicate it is preferable on September 24, 2021 by guest. Protected copyright. epididymis. Urgent urological review was Royal Prince Alfred not to operate on a non-acute scrotal mass until sought to obtain a histological diagnosis. results, including an STD screen, are available. Hospital Specialist Urine chlamydia polymerase chain reaction Centre, Newtown, This is particularly relevant in young men in NSW, Australia (PCR) was positive. Urethral culture for whom sexually transmitted causes of epidi- gonorrhoea, a midstream urine sample, and J H Rogers dymitis are common, and testicular malig- tumour markers were all negative. The patient nancies are most prevalent. Had the chlamydia Academic Unit of again denied other sexual partners in the past 5 PCR result not been available quickly, this Sexual Health years. Doxycycline was added. patient may have undergone an unnecessary Medicine, Sydney After 1 week the lump was softer, less tender, Hospital, Sydney, surgical procedure for suspected malignancy. NSW, Australia and clearly palpable posterior to the left testis. C S Estcourt The urologist felt the presentation was consist- ent with resolving epididymitis. Surgical explo- 1 Hori S, Tsutsumi Y. Histological diVerentiation between Correspondence to: ration was deferred. chlamydial and bacterial epididymitis: nondestructive and A M Ward, Sydney Sexual 1 proliferative versus destructive and abscess forming— Health Centre, Sydney The patient required 2 ⁄2 months of doxycy- immunohistochemical and clinicopathological findings. Hospital, GPO Box 1614, cline treatment. Serial ultrasounds showed Human Pathol 1995;26:402–7. Sydney, NSW, 2001, 2 Slanetz PA, Whitman GJ, Chew FS. Epididymal abscess. steady decrease in size of the mass until it was Radiologic-Pathologic Conferences of the Massachusetts Australia. impalpable. His wife had a negative cervical General Hospital. Am J Roentgenol 1995;164:376. 3 Molijn GJ, Bogdanowicz JF. Chlamydial epididymitis Accepted for publication chlamydia PCR but was treated with azithro- presenting as a solid asymptomatic scrotal mass. Br J Urol 18 June 1999 mycin as a contact. 1997;80:354..
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