0521779407-16 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18
1090 Orchitis and Epididymitis■Patients may have history of urinary tract infection as dysuria or
frequency.
■Infection could follow urinary tract instrumentation or surgery.
■<5 years of age, it is often associated with anatomic defects.Signs & Symptoms
■Tender swelling of the posterior aspect of the scrotum with erythema
is found early.
■Later, involvement of the entire scrotum and the testes may be
present.
■Temperature elevation is present in about one third of pts.
■A urethral discharge could be apparent in patients with sexually
transmitted infections.
■A hydrocele can be present.
■Findings consistent with viral infections are present with mumps
(rare with vaccine) or other viral infections.tests
Laboratory
■Urinalysis with culture is indicated in those >35 years of age.
■Do Gram stain of urethral exudate or first void urine (5 ml) for poly-
morphonuclear leukocytes, if <35.
■Do nucleic acid amplification test (Gen-probe on intraurethral swab
or LCR or PCR on first void urine for Neisseria gonorrhoeae and
Chlamydia trachomatis).Other Screening Tests
■If sexually transmitted, do syphilis serology and HIV counseling and
testing.
■If urinary tract infection with fever, do blood cultures two times.Imaging
■If symptoms do not improve within 3 days of antibiotic therapy or
if complications occur during the course of epididymitis, do ultra-
sound.Biopsy
■Biopsy may be indicated in patients with chronic epididymitis.
differential diagnosis
■Testicular torsion is a surgical emergency to be considered in adoles-
cent boys with onset of sudden pain: do high-resolution ultrasound.