Epididymitis (epididymo-orchitis) often presents with tes-ticular pain or swelling. It is usually unilateral, with a palpable, tender epididymis and possibly hydrocele. Risk factors include STI, insertive anal intercourse, invasive urinary tract procedures, and anatomic urinary tract disorders. Anatomic abnormalities are the most likely explanation in children. Epididymitis may occur as an STI in men during insertive anal intercourse or in men older than 35 who have undergone invasive procedures (e.g., cystoscopy). The differential diagnosis includes trauma, infarction, testicular cancer, and testicular torsion. Testicular cancer can be misdiagnosed as epididymitis. Thus, family physicians should emphasize close follow-up.

Chlamydia trachomatis and Neisseria gonorrhoeae cause most cases in men younger than 35 and usually coexist with asymptomatic urethritis (CDC, 2006). Other causative organisms include gram-negative enteric bacteria. Fungi and tuberculosis are other possible infectious causes.

Treatment includes antibiotics, analgesia, and scrotal elevation. In patients in whom gonorrhea or chlamydia is the likely cause, ceftriaxone (single dose, 250 mg IM) and doxycycline (100 mg twice daily for 10 days) is the treatment of choice. In patients who are allergic to these, or likely to have an enteric organism as the cause, 10 days of treatment with ofloxacin or levofloxacin is appropriate (CDC, 2006; del Rio, 2007).

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