Epididymitis is an inflammation of the epididymis caused by infection or trauma. The causative agent responsible for infection is a function of age and sexual behavior. In adolescents, C. trachomatis and N. gonorrhoeae are most common, responsible for approximately two-thirds of adolescent infection, but coliform organisms, Pseudomonas, and gram-positive cocci must be considered in youth who have engaged in anal intercourse.

The patient will present with an acute onset of scrotal pain and swelling, often accompanied by urinary frequency, dysuria, and urethral discharge. Fever is a sign of systemic infection. The epididymis is swollen and tender. Early in the course of the infection, the epididymis is easily discernible from the testicle, but with progression, the testis becomes involved, producing epididymoorchitis, thereby making it difficult to differentiate the epididymis from a swollen and tender testicle. The cremasteric reflex may be present or absent.

Proper STD evaluation is similar to that outlined for urethritis (

Fig. 3-6). Epididymitis is often difficult to differentiate from torsion of the spermatic cord. Radiologic techniques can be used to distinguish these two clinical entities (Fig. 3-6 and

Table 3-13).

If chlamydial or gonococcal epididymitis is suspected, treatment should include ceftriaxone, 125 mg IM, followed by a 10-day course of doxycycline, 100 mg BID (

Table 3-17). For infection likely caused by enteric organisms or in those with allergies to cephalosporins or tetracyclines, suggested treatment includes ofloxacin, 300 mg PO BID for 10 days. All sexual partners should be contacted for evaluation and treatment. Additional therapy should include scrotal elevation and analgesics.

Epididymitis usually resolves without sequelae if treatment is administered promptly. However, there are some indications that oligo- or azoospermia may result, particularly if C. trachomatis was the etiologic agent. Other sequelae include atrophy, infarct, or abscess formation.