From the Guidelines
Scrotal cellulitis requires prompt antibiotic treatment with coverage for Staphylococcus aureus and Streptococcus species, and the recommended duration of antimicrobial therapy is 5 days, but treatment should be extended if the infection has not improved within this time period 1.
Treatment Approach
The recommended approach is empiric antibiotic therapy with coverage for Staphylococcus aureus and Streptococcus species. First-line treatment typically includes:
- Dicloxacillin 500mg orally four times daily
- Cephalexin 500mg orally four times daily
- Clindamycin 300-450mg orally four times daily for 5 days, which can be extended if the infection has not improved within this time period 1
Additional Measures
Patients should also:
- Apply warm compresses to the area for 15-20 minutes several times daily
- Take over-the-counter pain relievers like acetaminophen or ibuprofen as needed
- Keep the area clean and dry
- Use scrotal elevation with supportive underwear to help reduce swelling and pain
Monitoring and Follow-up
Patients should seek immediate medical attention if they develop:
- Fever over 101°F
- Increasing pain
- Spreading redness
- Purulent drainage The infection typically occurs when bacteria enter through breaks in the skin, with risk factors including poor hygiene, excessive sweating, skin conditions, obesity, and diabetes 1. Without proper treatment, the infection can spread to deeper tissues or the bloodstream, potentially causing serious complications.
Severe Cases
For more severe cases or if MRSA is suspected, trimethoprim-sulfamethoxazole DS twice daily or doxycycline 100mg twice daily may be used, and vancomycin or another antimicrobial effective against both MRSA and streptococci is recommended 1.
From the Research
Causes and Symptoms of Scrotal Cellulitis
- Scrotal cellulitis is caused by bacterial infections, with beta hemolytic streptococci being the most common cause 2.
- The infection can also be caused by Clostridium, which can result from a perirectal abscess 2.
- Symptoms of scrotal cellulitis include intense swelling of the scrotum, pain, and redness.
- If left untreated, scrotal cellulitis can lead to devascularization of the scrotal and penile skin, resulting in gangrene 2.
Treatment of Scrotal Cellulitis
- Immediate treatment of the bacterial infection with antibiotics such as penicillin is essential 2.
- In cases where gangrene develops, radical debridement of the necrotic tissue and a wide margin of adjacent inflamed skin must be undertaken 2.
- Continual monitoring of the microflora of the debrided wound is essential for the selection of the appropriate antibiotic against any secondary intruders 2.
- Empiric outpatient therapy with trimethoprim-sulfamethoxazole, cephalexin, or clindamycin can be effective for cellulitis, including scrotal cellulitis 3.
- Cephalexin and dicloxacillin have been shown to be equally effective in treating staphylococcal skin and skin structure infections, including cellulitis 4.
Diagnosis and Management
- There is no gold standard diagnostic test for cellulitis, making it a potentially challenging condition to distinguish from other mimickers 5.
- Physical examination and thorough history can help narrow the differential diagnosis of cellulitis and minimize unnecessary hospitalization 5.
- Antibiotic selection is determined by patient history and risk factors, severity of clinical presentation, and the most likely microbial culprit 5.
- Fournier's gangrene, a polymicrobial subset of necrotizing fasciitis affecting the genital region, can masquerade as perineal and scrotal cellulitis, and requires early recognition and intervention 6.