Epididymitis
Epididymitis: Excerpt from Handbook of Diseases
This infection of the epididymis, the testicle’s cordlike excretory duct, is one of the most common infections of the male reproductive tract. It usually affects adults and is rare before puberty. Epididymitis may spread to the testicle itself, causing orchitis; bilateral epididymitis may cause sterility.
Causes
Epididymitis usually results from such organisms as Chlamydia trachomatis or Neisseria gonorrhoeae in sexually active men under age 35 and from urinary pathogens in older men. Epididymitis can result from an existing urinary tract infection or prostatitis and reach the epididymis through the lumen of the vas deferens.
Rarely, epididymitis is secondary to a distant infection, such as pharyngitis or tuberculosis, that spreads through the lymphatics or, less commonly, the bloodstream.
Other causes include trauma, gonorrhea, syphilis, and a chlamydial infection. Trauma may reactivate a dormant infection or initiate a new one. Epididymitis is a complication of prostatectomy and may also result from chemical irritation by extravasation of urine through the vas deferens.
Signs and symptoms
The key symptoms are pain, extreme tenderness, and swelling in the groin and scrotum. Other clinical effects include high fever, malaise, and a characteristic waddle — an attempt to protect the groin and scrotum during walking. An acute hydrocele may also occur as a reaction to the inflammatory process.
Diagnosis
Clinical features suggest epididymitis, but the actual diagnosis is made with the aid of the following laboratory tests:
❑ Urinalysis shows an increased white blood cell (WBC) count, indicating infection.
❑ Urine culture and sensitivity tests may identify the causative organism.
❑ Serum WBC count of more than 10,000/µl indicates infection.
❑ Scrotal ultrasonography may help differentiate acute epididymitis from other conditions such as testicular torsion, which is a surgical emergency.
Treatment
The goal of treatment is to reduce pain and swelling and combat infection. Therapy must begin immediately, particularly in the patient with bilateral epididymitis, because sterility is always a threat.
During the acute phase
Treatment consists of bed rest, scrotal elevation with towel rolls or adhesive strapping, broad-spectrum antibiotics, and analgesics.
An ice bag applied to the area may reduce swelling and relieve pain. (Heat is contraindicated because it may damage germinal cells, which are viable only at or below normal body temperature.) When pain and swelling subside and allow walking, an athletic supporter may prevent pain.
CLINICAL TIP: Occasionally, corticosteroids may be prescribed to help counteract inflammation, but their use is controversial.
Prevention
In the older patient undergoing open prostatectomy, bilateral vasectomy may be necessary to prevent epididymitis as a postoperative complication; however, antibiotic therapy alone may prevent it. When epididymitis is refractory to antibiotic therapy, epididymectomy under local anesthetic is necessary.
Special considerations
❑ Watch closely for abscess formation (a localized hot, red, tender area) and extension of the infection into the testes. Closely monitor temperature, and ensure adequate fluid intake.
❑ Because the patient is usually uncomfortable, administer analgesics as necessary. During bed rest, check often for proper scrotum elevation.
❑ Before discharge, emphasize the importance of completing the prescribed antibiotic therapy, even after symptoms subside. Infected sexual partners may also need treatment.
❑ If the patient faces the possibility of sterility, suggest supportive counseling as needed.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
More About Epididymitis
More Medical Textbooks Online about Epididymitis
Review other book chapters online related to Epididymitis:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
|
|
More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
|
|
» Next page:
TESTICULAR PAIN (Differential Diagnosis in Primary Care)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
