Differential Diagnosis for Epididymitis vs UTI

When considering the differential diagnosis for a patient presenting with symptoms that could indicate either epididymitis or a urinary tract infection (UTI), it's crucial to approach the diagnosis systematically. The following categories help in organizing the thought process:

• Single Most Likely Diagnosis
  • Epididymitis: This is often the most likely diagnosis in men, especially younger men, presenting with acute scrotal pain, swelling, and tenderness, particularly if there's a history of recent sexual activity or a known sexually transmitted infection (STI).
• Other Likely Diagnoses
  • Urinary Tract Infection (UTI): While more common in women, UTIs can occur in men and present with dysuria, frequency, urgency, and sometimes abdominal or flank pain.
  • Prostatitis: Inflammation of the prostate gland can present with similar symptoms to epididymitis, including pain and discomfort in the pelvic area, and can be considered, especially in older men or those with a history of prostate issues.
• Do Not Miss Diagnoses
  • Testicular Torsion: A medical emergency that requires immediate attention. It presents with sudden, severe testicular pain, often accompanied by nausea and vomiting. Missing this diagnosis can result in the loss of the testicle.
  • Pyelonephritis: An infection of the kidney, which can present with severe flank pain, fever, and chills. It's a serious condition that requires prompt antibiotic treatment.
  • Sepsis: Although less common, any infection, including epididymitis or UTI, can lead to sepsis, a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs.
• Rare Diagnoses
  • Orchitis: Inflammation of one or both testicles, usually caused by bacterial or viral infections. It can present similarly to epididymitis but is less common.
  • Fournier's Gangrene: A rare but serious condition characterized by necrotizing fasciitis of the genitalia, which can start with symptoms similar to epididymitis or UTI but rapidly progresses to severe pain, swelling, and skin necrosis.

Each of these diagnoses has distinct implications for treatment and patient outcomes, emphasizing the importance of a thorough evaluation and consideration of the entire differential diagnosis spectrum.