What is the treatment for a scrotal abscess?

Treatment of Scrotal Abscess

The definitive treatment for a scrotal abscess is surgical incision and drainage, which should be performed promptly to prevent progression to more severe conditions such as Fournier's gangrene. 1

Diagnostic Approach

• Evaluate for:
  • Scrotal swelling, redness, pain, and tenderness
  • Fluctuance in the affected area
  • Fever and signs of systemic infection
  • Underlying conditions (especially diabetes mellitus) that increase risk 2, 3
• Consider imaging (CT scan) in stable patients to determine extent of infection 1
  • Note: Imaging should never delay surgical intervention if clinical diagnosis is clear

Treatment Algorithm

Surgical Management

1. Incision and drainage:

   • Make incision at point of maximal fluctuance 1
   • Ensure complete evacuation of purulent material
   • Consider collecting samples for culture before starting antibiotics 1

2. Post-drainage management:

   • Consider placement of drain to prevent premature closure in larger abscesses 1
   • Simple dry dressing is often sufficient for smaller abscesses

Antibiotic Therapy

• Indications for antibiotics:

  • Presence of sepsis or systemic infection
  • Surrounding soft tissue infection
  • Immunocompromised patients (including diabetics) 1

• Recommended regimens:

  • For typical bacterial abscesses: Amoxicillin-clavulanate 875/125 mg PO twice daily
  • If MRSA suspected: Trimethoprim-sulfamethoxazole or doxycycline
  • For severe infections: Consider IV antibiotics initially

Supportive Care

• Analgesics for pain management
• Scrotal elevation to reduce edema
• Adequate hydration
• Blood glucose control in diabetic patients 2, 3

Special Considerations

Diabetic Patients

• Higher risk for severe infections and progression to Fournier's gangrene 2
• Require more aggressive management:
  • Early surgical intervention
  • Broader antibiotic coverage
  • Strict glycemic control

Follow-up Care

• Reassess after 48-72 hours to ensure improvement
• Continue antibiotics for 5-7 days depending on clinical response
• Consider follow-up imaging if resolution is in question

Potential Complications

• Progression to Fournier's gangrene (necrotizing fasciitis)
• Spread to adjacent structures
• Bacteremia and systemic infection
• Recurrence if drainage is inadequate
• Fistula formation (as seen in some case reports) 3, 4

Prevention

• Prompt treatment of predisposing conditions:
  • Epididymitis
  • Urethral strictures
  • Perforated appendicitis (rare cause) 5
• Good hygiene practices
• Optimal management of diabetes and other immunocompromising conditions

Remember that scrotal abscesses can rapidly progress to life-threatening conditions, particularly in diabetic or immunocompromised patients, making early and aggressive intervention essential.