How to diagnose epididymitis and penile discharge?

From the Guidelines

Epididymitis and penile discharge should be diagnosed through a combination of clinical evaluation, laboratory tests, and imaging studies, prioritizing prompt identification and treatment to prevent complications, as recommended by the European Association of Urology guidelines 1. To diagnose epididymitis and penile discharge, a healthcare provider will typically start with a detailed medical history and physical examination, focusing on the genital area to check for signs of infection or inflammation.

Key Diagnostic Steps:

• Clinical assessment to identify symptoms such as acute scrotal pain, swelling, and penile discharge
• Laboratory tests including midstream urine for culture, urethral swab/smear, and first voided urine for nucleic acid amplification test (NAAT) to detect sexually transmitted infections (STIs) like gonorrhea or chlamydia 1
• Scrotal ultrasound examination to visualize the epididymis and rule out other conditions like testicular torsion 1
• Blood tests to check for elevated white blood cell counts indicating infection

Importance of Prompt Diagnosis:

Prompt diagnosis and treatment are crucial to prevent complications such as abscess formation, reduced fertility, or chronic pain 1. The European Association of Urology guidelines provide a diagnosis and treatment algorithm for epididymitis, emphasizing the importance of clinical assessment, laboratory tests, and appropriate antibiotic therapy 1. In cases where gonorrhea is likely, treatment with ceftriaxone 1000 mg i.m. or i.v. plus a course of an antibiotic active against Chlamydia trachomatis is recommended 1. Overall, a comprehensive diagnostic approach is essential for effective management of epididymitis and penile discharge, prioritizing patient outcomes in terms of morbidity, mortality, and quality of life 1.

From the FDA Drug Label

Acute epididymo-orchitis caused by N. gonorrhoeae: 100 mg, by mouth, twice a day for at least 10 days. Acute epididymo-orchitis caused by C. trachomatis: 100 mg, by mouth, twice a day for at least 10 days Uncomplicated gonococcal infections in adults (except anorectal infections in men):100 mg, by mouth, twice a day for 7 days. Uncomplicated urethral, endocervical, or rectal infection in adults caused by Chlamydia trachomatis: 100 mg, by mouth, twice a day for 7 days. Nongonococcal urethritis (NGU) caused by C. trachomatis or U. urealyticum: 100 mg, by mouth, twice a day for 7 days. Urethritis and cervicitis due to Chlamydia trachomatis or Neisseria gonorrhoeae.

The diagnosis of epididymitis and penile discharge is not directly addressed in the provided drug labels. However, the labels do provide information on the treatment of infections that may cause these conditions, such as:

• Gonococcal infections: caused by N. gonorrhoeae
• Chlamydial infections: caused by C. trachomatis
• Nongonococcal urethritis (NGU): caused by C. trachomatis or U. urealyticum To diagnose epididymitis and penile discharge, a physical examination, medical history, and laboratory tests (such as urine tests, swab tests, or blood tests) would be necessary to determine the underlying cause of the symptoms 2.

From the Research

Diagnosis of Epididymitis

• Epididymitis is commonly diagnosed based on patient age and the likely causative organisms 3
• Physical findings include a swollen and tender epididymis with the testis in an anatomically normal position 3
• Scrotal ultrasonography, urinalysis, and urine culture can be performed to diagnose acute epididymitis 4
• Patients with positive urine culture are significantly younger and more likely to have a history of sexual contact at least two weeks prior to onset of epididymitis 4

Diagnosis of Penile Discharge

• Penile discharge can be a symptom of urethritis, which is often caused by sexually transmitted organisms such as Neisseria gonorrhoeae and Chlamydia trachomatis 5
• A thorough sexual history, genital examination, and evaluation for objective and laboratory evidence of infection are necessary for diagnosis 5
• Urine tests, such as urinalysis and urine culture, can be used to diagnose urethritis and epididymitis, but may have limited value in prepubertal boys 6

Diagnostic Tests

• Urinalysis can be used to diagnose epididymitis, but may have limited value in prepubertal boys 6
• Urine culture can be used to identify the causative organism, but may be sterile in many cases 4, 6
• Scrotal ultrasonography can be used to evaluate the epididymis and testis 4
• Blood tests may be used to evaluate for signs of infection or inflammation 6