From the Guidelines
The diagnostic approach for epididymitis involves a thorough clinical evaluation combined with targeted laboratory testing, prioritizing the identification of the underlying cause to guide appropriate treatment and prevent complications such as testicular torsion. This approach is crucial for minimizing morbidity, mortality, and improving quality of life in patients with epididymitis. Initially, a detailed history and physical examination should be performed, focusing on urinary symptoms, sexual activity, and scrotal pain characteristics 1.
Key Components of Diagnostic Approach
- Laboratory tests include urinalysis and urine culture to identify bacterial infections, along with STI testing (particularly for gonorrhea and chlamydia) in sexually active patients.
- A complete blood count may reveal elevated white blood cells indicating infection.
- Doppler ultrasound of the scrotum is crucial to differentiate epididymitis from testicular torsion, which requires immediate surgical intervention, as it typically shows increased blood flow to the epididymis in epididymitis, versus decreased flow in torsion 1.
- In men over 50 or those with risk factors, post-void residual urine measurement may be indicated to assess for urinary obstruction.
Treatment Considerations
Empiric antibiotic therapy is often initiated while awaiting culture results, with regimens tailored to the patient's age and risk factors. For sexually transmitted epididymitis, ceftriaxone 500mg IM once plus doxycycline 100mg twice daily for 10 days is recommended, while for non-STI cases, fluoroquinolones like levofloxacin 500mg daily for 10 days are often used 1. This comprehensive approach ensures proper diagnosis and appropriate treatment while ruling out other serious conditions, thereby prioritizing the reduction of morbidity, mortality, and improvement of quality of life.
From the Research
Diagnostic Approach for Epididymitis
The diagnostic approach for epididymitis involves a combination of physical examination, medical history, and laboratory tests.
- Physical examination: typically presents with a swollen and tender epididymis with the testis in an anatomically normal position 2.
- Medical history: to identify potential causes of epididymitis, such as sexually transmitted infections (STIs) or urinary tract infections (UTIs) 2, 3.
- Laboratory tests:
- Urinalysis and urine culture to detect bacterial infections, such as Escherichia coli (E. coli) 4, 3.
- Nucleic acid amplification testing (NAAT) for chlamydia and gonorrhea, which are common causes of epididymitis in sexually active males aged 14-35 years 4, 2.
- Blood tests to detect signs of infection, such as elevated white blood cell count 5.
Special Considerations
- In prepubertal boys, epididymitis is often idiopathic, and urine tests (urinalysis, urine culture) are usually negative 6.
- In men older than 35 years, epididymitis is usually caused by enteric bacteria, and levofloxacin or ofloxacin alone is sufficient to treat these infections 2.
- In men who practice insertive anal intercourse, an enteric organism is also likely, and ceftriaxone with 10 days of oral levofloxacin or ofloxacin is the recommended treatment regimen 2.