questions 2

Epididymitis

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Topic updated on 08/17/17 11:01am

Snapshot
  • A 60-year-old man with a history of benign prostatic hyperplasia presents with one-sided testicular pain and urinary frequency. He also reports pain with urination. Physical exam reveals a swollen right testicle with substantial induration. Urinalysis reveals positive leukocyte esterase and 20 wbc/hpf. He is prescribed antibiotics for epididymitis.
Introduction
  • Clinical definition
    • inflammation of epididymis with symptoms of < 6 weeks
  • Epidemiology
    • incidence
      • 25 per 100,000 persons
    • demographics
      • men 18-35 years old
    • risk factors
      • sexual activity
      • bladder outlet obstruction
  • Etiology
    • pathogens from sexually transmitted infections in men less than 35 years of age
      • Neisseria gonorrhoeae
      • Chlamydia trachomatis
    • urinary tract pathogens in men greater than 35 years of age 
      • Escherichia coli
      • Pseudomonas aeruginosa
  • Pathogenesis
    • consequence of sexually transmitted disease or urinary tract infection
      • retrograde ascent of pathogen
    • bladder outlet obstruction
      • bacteriuria and subsequent retrograde ascent of pathogen
  • Prognosis
    • resolves with antibiotics
Presentation
  • Symptoms
    • testicular pain and often unilateral
    • lower abdominal pain
    • urinary frequency or urgency
    • urinary dysuria
  • Physical exam
    • fever
    • testicular erythema, tenderness, and induration
    • cremasteric reflex intact
    • Prehn's sign
      • decrease in pain with scrotal elevation
Imaging
  • epididymitisUltrasound
    • indications
      • to rule out testicular torsion
    • findings
      • enlarged and thick epididymis
      • increased blood flow
      • may also find reactive hydrocele
Studies
  • Labs
    • urethral swab
      • Gram stain or methylene blue stain showing white blood cells
    • urine
      • positive leukocyte esterase
      • 10 or more wbc/hpf
      • nucleic amplification testing for Chlamydia and Neisseria
Differential
  • Testicular torsion
    • absent cremasteric reflex
Treatment
  • Medical
    • antibiotics guided by sexual and urologic history
      • drugs
        • ceftriaxone and doxycycline
          • for sexually transmitted diseases
        • fluroquinolones
          • for enteric pathogen
Complications
  • Sepsis
  • Testicular atrophy


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Qbank (1 Questions)

TAG
(M2.RL.82) A 68-year-old male presents with pain and tenderness of his right testicle. These symptoms started gradually over the last day. Vital signs are as follows: T 99.8 F, HR 75, BP 125/80 mmHg, RR 12. On physical exam, he has severe pain when the testicle is palpated which is lessened with elevation of the involved testicle. Doppler ultrasound shows normal blood flow in both testes. Which of the following organisms is the most likely pathogen in this patient's condition? Topic Review Topic

1. N. gonorrhoeae
2. C. trachomatis
3. E. coli
4. S. aureus
5. S. epidermidis

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