Highlights & Basics
- Acute epididymitis is inflammation of the epididymis causing pain and swelling that develops over the course of a few days and lasts <6 weeks. It is usually unilateral.
- In sexually active men, epididymitis is most commonly caused by sexually transmitted organisms including Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium.
- In older men, the causative organisms are often enteric pathogens, and epididymitis may be associated with bladder outlet obstruction, recent instrumentation of the urinary tract, or systemic illness.
- Diagnostic tests include a Gram stain of urethral secretions, and urine specimens for nucleic acid amplification tests for C trachomatis, N gonorrhoeae, and M genitalium (where available). Urine microscopy and culture is also indicated if urinary pathogens are suspected.
- Treatment relies on supportive measures, including bed rest, scrotal elevation, and analgesics, in conjunction with empiric antibiotic therapy based on the patient's age, and clinical and sexual history. Once diagnostic test results are available, antibiotics can be adjusted to target the causative organism(s).
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
British Association for Sexual Health and HIV (BASHH). 2019 UK national guideline for the management of epididymo-orchitis. 2019 [internet publication].[Full Text]
American College of Radiology. ACR appropriateness criteria: acute onset of scrotal pain - without trauma, without antecedent mass. 2014 (revised 2018) [internet publication].[Full Text]
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.[Abstract][Full Text]
Street EJ, Justice ED, Kopa Z, et al. The 2016 European guideline on the management of epididymo-orchitis. Int J STD AIDS. 2017 Jul;28(8):744-9.[Abstract]
European Association of Urology. Guidelines on urological infections. Mar 2022 [internet publication].[Full Text]
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