0521779407-16 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18
Orchitis and Epididymitis 1091■Testicular infarction or tumors such as lymphoma can cause
swelling.
■Abscess can develop from a perforated viscus.
■External infection of scrotum with Candida can occur in immuno-
compromised or diabetic patients.
management
What to Do First
■Examine the urethral secretions or first void urine.
■If <5 years of age, initiate urologic evaluation.
■If <15 years of age with no evidence of urinary tract infection, observe
without specific treatment.
General Measures
■Bed rest, scrotal elevations, analgesic, and local ice packs are helpful.
■Discontinue amiodarone, as may be a side effect of drug.
specific therapy
■If sexually transmitted, administer ceftriaxone 250 mg IM in single
dose PLUS Doxycycline 100 mg p.o. bid for 21 days for Chlamydial
and gonococcal infections.
■If urinary tract infection is present in patient >35 years of age, admin-
ister levofloxacin 500 mg q day or gatifloxacin 400 mg QD for 21 days.
■If systemic symptoms with evidence of sepsis, hospitalize and
administer parenteral therapy as levofloxacin 500 mg IV q day or
combination of extended-spectrum cephalosporin as Cefepime 1–2
g q12h with an aminoglycoside as gentamicin 5–7 mg/kg q24h.
■If evidence of chronic granulomatous infection, do biopsy of epididy-
mal tissue and administer appropriate antituberculous or antifungal
therapy.
Side Effects & Contraindications
■Ceftriaxone
➣Side effects: rare allergic reactions
➣Contraindications:
absolute: penicillin hypersensitivity. Give alternative therapy
with spectinomycin or quinolone.
■Doxycycline
➣Side effects: nausea, vomiting, diarrhea, photosensitivity and
rarely liver function abnormalities
➣Contraindications:
absolute: hypersensivity to tetracycline
relative: patient unlikely to be compliant