EPIDIDYMITIS TABLES OF EVIDENCE STUDY ETIOLOGY CLINICAL COMPLICATIONS DIAGNOSIS RECOMMENDED CITATION DESIGN PRESENTATION TREATMENT Tracy CR, et al. Review Infectious *Inflammation of the Chronic *Urethral General Diagnosis and Article *C. trachomatis epididymis presenting as Epididymitis Gram’s stain *Bed rest Management of *N. gonorrhoeae pain and swelling, with > 5 *Scrotal elevation Epididymitis. Urol *E.coli and other generally occurring on Pain of at least 3 WBCs/oil *Analgesics Clin N Am. 2008; coliforms one side months duration – immersion field *Non-steroidals 35:101-108 *Mycoplasma May account for up genitalium and sp. to 80% of men *NAATs Antibiotics *U. urealuticum presenting to the Younger than 35 y/o Objective findings may *Urinalysis and *M. tuberculosis urology clinic with Ceftriaxone 250 mg IM *Brucella include positive urine scrotal pain urine culture for X 1 *Viral – culture, fever, erythema children and Doxycycline 100 mg po bid Enterovirus, of the scrotal skin, men over 35 X 10 days Adenovirusm, CMV leukocytosis, urethritis, years old hydrocele and *Testing for Older than 35 y/o Non-Infectious involvement of the Levofloxacin 500 mg q day adjacent testicle other STIs and *Sarcoid HIV X 10 days *Bechet’s disease Ofloxacin 300 mg bid X 10 *Amiodarone days *Henoch-Schӧnlein Purpura Cephalosporin Allergy Levofloxacin or ofloxacin Desensitization with fluoroquinolone resistance STUDY ETIOLOGY CLINICAL COMPLICATIONS DIAGNOSIS RECOMMENDED CITATION DESIGN PRESENTATION TREATMENT Trohan, TH, et al. Review As Above plus H. Same As Above *Sepsis Same As Above Same As Above Epididymitis and Article influenzae Orchitis: An *High index of suspicion *Abscess *Plus the recommendation for torsion of Azithromycin 1 gm po in Overview. *Infertility American Family a single dose as substitution *Differential diagnosis for 10 days of Doxycycline Physician. with ultrasound findings *Extension of the 2009;71:583-587 infection when compliance is of *Symptoms of lower concern urinary tract infection – Supportive care as above fever, frequency, urgency, dysuria, hematuria Follow-up recommended 3- *Prehn sign – relief of 7 days after initiation of pain with elevation of treatment to evaluate for the testicle with clinical improvement and epididymitis (worse pain for the presence of a upon elevation with testicular mass torsion) Street, E, et al. Guidelines As Above plus Same as in Tracy review *Reactive hydrocele Crossover of etiology with BASHH UK Mumps and article age groups – complete Guideline for the Candida *Abscess or sexual history imperative management of infarction of the when deciding on therapy epididymo-orchitis, testicle 2010. International *Ceftriaxone 500 mg IM *Infertility – poorly X1and Doxycycline 100 mg Journal of STD understood &AIDS. bid po for 10-14 days 2011;22:361-365 For enterics – Ofloxacin or Ciprofolxacin PCN or tetracycline Allergy - Ofloxacin 200mg bid for 14 days STUDY ETIOLOGY CLINICAL COMPLICATIONS DIAGNOSIS RECOMMENDED CITATION DESIGN PRESENTATION TREATMENT Tracy CR and Retrospective Chlam. Bacteria Results Costabile RA. The Database <18 <18 18-35 years old evaluation and Review 0/4 1/17 *29% had treatment of acute (0%) (7%) appropriate work-up *University of Epididymitis in a Virginia *50% were treated large university 18-35 18-35 Health System appropriately based population: 8/48 4/40 are CDC guidelines Database (17%) (10%) >35 years old being followed? *Queried for *39% had World J Urol. epididdymitis >35 >35 appropriate work-up 2009;27:259-263 from 1999- 0/21 37/99 2005 (0%) (37%) *85% were treated appropriately .