Epididymitis

Epididymitis in men is most often caused by chlamydia (C. Trachomatis) and neyeriami (N. Gonorrhoeae). Epididymitis due to sexual contact often occurs asymptomatically.

[1], [2], [3], [4]

Causes of the epididymitis

The most common cause of epididymitis in men younger than 35 years is C. Trachomatis or N. Gonorrhoeae. In addition, epididymitis, caused by sexually transmitted Escherichia coli, is often observed in homosexual men who are an active partner in anal intercourse. Epididymitis resulting from sexual contact is usually accompanied by urethritis, often asymptomatic. Epididymitis, which is not associated with sexual transmission, is usually associated with urinary infection due to Gram-negative enterobacteria, and is most commonly found in men over 35 years old, as well as in men who have recently undergone instrumental or surgical intervention on the urinary tract, or who have anatomical defects.

Although most patients can be treated as outpatients, hospitalization is indicated in severe pain, when other diseases such as torsion, testicular infarction, abscess, or when the patient has a fever can not be ruled out.

[5], [6], [7], [8], [9]

Symptoms of the epididymitis

Symptoms of epididymitis are one-sided pain and tension in the testicle. If epididymitis is accompanied by a testicle displacement, the question of surgical intervention should be considered in all cases, especially in adolescents. Immediate examination for the presence of bias may be indicated by the sudden onset of a pain attack, very severe pain in the testicle or, if the test results that can be carried out on the first visit, do not allow the diagnosis of urethritis or urinary tract infection.

[10], [11], [12], [13], [14]

Diagnostics of the epididymitis

Epididymitis is recognized on the basis of the following procedures:

• Gram stain of a swab of exudate from the urethra or material from the intraurethral tampon for the diagnosis of urethritis (> 5 polymorphonuclear leukocytes in the field of vision with immersion microscopy) or to exclude gonococcal infection.
• Culture examination of urethral exudate or material from the intraurethral tampon or amplification DNA tests (with material from the intraurethral tampon, or the first portion of urine) on N. Gonorrhoeae, and

C. Trachomatis.

• The study of the first portion of urine on leukocytes with a negative result of a smear stained by Gram. Culture study and examination of a Gram-stained smear from uncentrifuged urine.
• Serologic research on syphilis, as well as counseling and testing for HIV infection.

[15], [16], [17], [18], [19], [20], [21]

Treatment of the epididymitis

Empirical treatment of epididymitis is shown before the results of culture tests are obtained. Epididymitis caused by N. Gonorrhoeae and C. Trachomatis is treated with the goal of:

• microbiological cure,
• relief of symptoms and signs
• prevention of transmission of infection to others and
• reduce the risk of possible complications, such as infertility or chronic pain syndrome.

Epididymitis: treatment for recommended regimens

Epidemiditis, caused by gonococcal or chlamydial infection:

• Ceftriaxone 250 mg IM once
• plus Doxycycline 100 mg orally 2 times a day for 10 days.

Epidemiditis caused by intestinal microorganisms, or if the patient has allergies to cephalosporins and / or tetracyclines:

• Ofloxacin 300 mg orally 2 times a day for 10 days.

As an adjunct to treatment until the temperature decreases and the local inflammation disappears, a bed regimen is recommended that supports the scrotal dressing and the appointment of analgesics.

[22], [23], [24], [25], [26], [27]

Follow-up care for patients who have epididymitis

Lack of improvement within 3 days requires a revision of both the diagnosis of epididymitis, and treatment, as well as possible hospitalization. If swelling and tenderness remain after the completion of antimicrobial therapy, consideration should be given to the possibility of testicular cancer, tuberculosis or fungal epididymitis.

[28]

Management of sexual partners

Patients in whom epididymitis is caused by N. Gonorrhoeae should be instructed about the need for examination and treatment of sexual partners. The sex partners of such patients should be examined and treated if contact occurs within 60 days of the onset of symptoms in the patient.

Patients who have epididymitis should also be instructed to abstain from sexual intercourse until the patient and partner (s) are cured. If there is no possibility of microbiological confirmation of the cure, this means - until the end of treatment and the absence of symptoms in the patient and partner (s).

Special notes with epididymitis

HIV infection

Uncomplicated epididymitis in HIV-infected individuals requires treatment in the same way as people without HIV infection. However, in patients with a weakened immune system, there are more cases of disease caused by mycobacteria and fungi.