From the Guidelines
A testicle abscess requires immediate medical attention and typically needs surgical drainage along with antibiotic treatment, as recommended by the most recent guidelines 1. Treatment usually involves:
- Surgical drainage: This is the primary treatment to remove the pus and infected material.
- Antibiotics: Broad-spectrum antibiotics are typically started immediately, often before culture results are available. Common choices include:
- Ceftriaxone 1-2g IV daily plus
- Doxycycline 100mg orally twice daily This regimen is usually continued for 10-14 days, with a switch to oral antibiotics once improvement is seen, as suggested by the Infectious Diseases Society of America guidelines 1.
- Pain management: Over-the-counter pain relievers like ibuprofen or prescription pain medication may be necessary.
- Supportive care: Rest, scrotal elevation, and ice packs can help reduce swelling and discomfort.
The diagnosis of a testicular abscess often involves clinical assessment, scrotal ultrasound examination, and laboratory tests such as midstream urine for culture and urethral swab/smear, as outlined in the European Association of Urology guidelines 1. After treatment, follow-up care is crucial to ensure complete resolution and to prevent complications like infertility or chronic pain. Abstain from sexual activity until fully healed and complete the entire course of antibiotics. Testicular abscesses often result from untreated epididymitis or orchitis, which are typically caused by sexually transmitted infections or urinary tract infections. Prompt treatment of these underlying conditions can prevent abscess formation. In some cases, abscesses may be due to trauma or systemic infections spreading to the testicle.
Key considerations in the management of testicular abscesses include the need for prompt surgical drainage and antibiotic treatment, as well as the importance of addressing underlying conditions and preventing complications. The guidelines from the Infectious Diseases Society of America 1 and the European Association of Urology 1 provide a framework for the diagnosis and treatment of testicular abscesses, emphasizing the importance of individualized care and attention to patient-specific factors.
From the Research
Diagnosis of Testicular Abscess
- The diagnosis of testicular abscess can be made using scrotal ultrasonography, which can reveal a fluid collection within the tunica albuginea of the testis 2, 3, 4, 5.
- The patient may present with symptoms such as scrotal pain and swelling, fever, and testicular tenderness 2, 3, 4, 5.
- Intraoperative cultures can be used to identify the causative pathogen, such as Morganella morganii 2 or Pseudomonas aeruginosa 5.
Treatment of Testicular Abscess
- Surgical exploration and evacuation of the abscess can be an effective treatment option, with the goal of salvaging the residual viable testicular parenchyma 2, 3.
- Antibiotic therapy can be used to treat the underlying infection, with the choice of antibiotic depending on the causative pathogen 2, 3, 6, 5.
- In some cases, conservative treatment with oral antibiotics may be successful, avoiding the need for drainage or orchiectomy 6.
- However, in severe cases, orchiectomy and partial scrotectomy may be necessary to manage the non-viable testis and associated scrotal sinus 3, 4, 5.
- Early surgical decompression and frequent blood flow evaluation to the testis may be important to prevent testicular loss and necrosis 3, 5.