Epididymitis

Age: ‍ years old

Gender: male



HISTORY:

Presents with a ‍-‍day history of ‍testicular painscrotal swelling

Symptoms include:

‍testicular pain

‍scrotal swelling

‍redness

‍fever, up to ‍°, over ‍ ‍hoursdays

‍penile discharge

‍blood in semen

‍lower back pain

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍dysuria

‍urinary frequency



Onset was ‍gradualsudden, started ‍whileafter ‍

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍sexual activity

‍unprotected sex

‍recent urinary tract catheter or procedure

no history of: ‍epididymitis, ‍prostate infection, ‍sexually transmitted infections, ‍urinary tract infections, ‍prostate enlargement





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia





ASSESSMENT:

‍Epididymitis ‍likelysuspectedpossible

DDx: acute epididymitis, chronic epididymitis, STI, epididymo-orchitis, testicular torsion, inguinal hernia, hydrocele, varicocele, testicular cancer, prostatitis, urethritis, urinary tract infection, mumps orchitis, trauma to the scrotum, idiopathic scrotal edema, Fournier's gangrene





PLAN:

Investigations:

- Urinalysis

- Urine culture

- STI testing for chlamydia and gonorrhea

- Blood work: ‍CBC, ‍CRP, ‍creatinine

- Ultrasound of scrotum if does not resolve after 72 hours

Treatments:

- ‍Antibiotics

- ‍Analgesics

- Scrotal support

- Ice packs

- Sexual partners treatment

- Abstinence until treatment completed and symptoms resolved

Further care:

- Referral to urologist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as fever, vomiting, or increased pain

- Referral to ER if severe abdominal pain, severe vomiting, or fever occurs