Causes:Under age 35-40 yr, most are due to chlamydia, occasionally gonorrhea or ureaplasmas spread venereally; over age 35-40 yr, most due to gram-negative bacterial infections (Nejm 1978;298:301) caused by reflux of infected urine

Pathophys:Inflammation localized to epididymis only, testes spared

Rare under age 18 yr; peak incidence at age 32 yr

Sx:Gradual onset, although may first notice when hit lightly and report traumatic etiology

Si:Swollen, tender epididymis with normal, nontender testicle below

May last 7-10 d with rx, longer without bed rest

Abscess, chronic pain, infertility

r/o orchitis, usually viral; TESTICULAR TORSION—usually under age 18 yr, average age 14 yr, often have had episodes in past, and more acute onset often w N⁺V; must operate within 4-5 h to save 70%, only 15% saved at 10 h (Nejm 1977;296:338); risk for subsequent orchiectomy increases with age (Arch Pediatrs Adolesc Med 2005;159:1162)

Lab:

Bact:Urine culture

Urine:UA to r/o infection

Rx:

(Med Let 1999;41:86)

Ofloxacin 300 mg po bid × 10 d; or ceftriaxone 250 mg im × 1 then doxycycline 100 mg po bid × 10 d

Bed rest, scrotal support, NSAIDs