From the Guidelines
The treatment of a scrotal abscess requires prompt surgical drainage combined with antibiotic therapy, as the abscess is located in an area difficult to drain and is associated with a high risk of complications. According to the clinical practice guidelines by the Infectious Diseases Society of America 1, incision and drainage is the primary treatment for a cutaneous abscess, and antibiotic therapy is recommended for abscesses associated with certain conditions, including those in areas difficult to drain, such as the genitalia.
The procedure involves a small incision over the fluctuant area, evacuation of purulent material, and placement of a drain if the cavity is large. This procedure is typically performed under local anesthesia, though general anesthesia may be needed for extensive abscesses.
- Empiric antibiotic therapy should be started immediately, typically with broad-spectrum coverage such as clindamycin, trimethoprim-sulfamethoxazole, or a tetracycline, as recommended by the guidelines 1.
- The antibiotic regimen may be adjusted based on culture results, and cultures from abscesses and other purulent SSTIs are recommended in patients treated with antibiotic therapy, patients with severe local infection or signs of systemic illness, patients who have not responded adequately to initial treatment, and if there is concern for a cluster or outbreak 1.
- Post-procedure care includes daily warm compresses, regular cleansing with mild soap and water, and keeping the area dry.
- Pain management with acetaminophen or NSAIDs is usually sufficient.
- Patients should be advised to wear supportive underwear to minimize discomfort and follow up within 48-72 hours to assess healing. Scrotal abscesses commonly result from infected hair follicles, sebaceous glands, or Fournier's gangrene, with risk factors including poor hygiene, diabetes, and immunosuppression. Without proper treatment, these infections can spread rapidly through fascial planes, potentially leading to systemic infection.
From the Research
Treatment Options for Scrotal Abscess
- Surgical drainage of the abscess is a common treatment approach, as seen in cases where patients underwent incision and drainage of the scrotal abscess 2, 3.
- Antibiotic therapy is also crucial in the treatment of scrotal abscess, with the choice of antibiotic depending on the causative organism 2, 3, 4, 5.
- In some cases, a combination of surgical drainage and antibiotic therapy may be necessary for effective treatment 2, 3.
Antibiotic Regimens
- Cefazolin and amoxicillin were used to successfully treat a scrotal abscess caused by Prevotella bivia and Streptococcus agalactiae 2.
- Culture-directed antibiotic therapy was used to treat a scrotal abscess caused by Clostridium difficile 3.
- For epididymitis, which can present with similar symptoms to scrotal abscess, antibiotic regimens such as ceftriaxone with doxycycline or levofloxacin are recommended 4.
Importance of Underlying Cause
- Identifying and treating the underlying cause of the scrotal abscess is essential for effective management, as seen in cases where abdominal pathologies were associated with scrotal abscess 6.
- In some cases, treatment of the underlying cause may resolve the scrotal abscess without the need for additional intervention 6.