eMedicine Specialties > Emergency Medicine > Genitourinary

Epididymitis: Differential Diagnoses & Workup

Author: Catherine Tubridy, MD, Staff Physician, Combined Residency Program for Emergency Medicine and Internal Medicine, State University of New York Downstate/Kings County Hospital Centers
Coauthor(s): Richard Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Contributor Information and Disclosures

Updated: Sep 4, 2008

Differential Diagnoses

Hydrocele
Orchitis
Testicular Torsion
Urinary Tract Infection, Male

Other Problems to Be Considered

Epididymal cyst
Epididymal congestion following vasectomy
Spermatocele
Testicular tumor (hemorrhage into tumor)
Varicocele

Workup

Laboratory Studies

The following laboratory studies may be indicated for suspected epididymitis:

  • Urinalysis - Pyuria or bacteriuria (50%); urine culture indicated for prepubertal and elderly patients
  • CBC - Leukocytosis
  • Gram stain of urethral discharge, if present
  • Urethral culture, nucleic acid hybridization, and nucleic acid amplification tests (These tests aid in detection of N gonorrhoeae and C trachomatis.)
  • Performance of (or referral for) syphilis and HIV testing in patients with a sexually transmitted etiology
  • The utility of CRP and ESR to differentiate epididymitis from other causes of acute scrotum is currently being studied. See Under Investigation.

Imaging Studies

  • Imaging studies are often used to differentiate the more common epididymitis from testicular torsion. However, clinical judgment must guide interpretation of imaging results, as they are neither 100% sensitive or specific. Refer to the article Testicular Torsion.
  • Radionuclide scintigraphy
    • Radionuclide scintigraphy is used to assess testicle perfusion, yet it provides little anatomic information.
    • Decreased perfusion suggests torsion. Increased or normal perfusion suggests epididymitis but also may be reported with actual torsion.
  • Color-coded Doppler ultrasonography
    • This type of ultrasonography assesses perfusion of the testicle and anatomy of the scrotal contents.
    • A normal testicle with markedly diminished Doppler wave pulsation represents torsion.
    • A thickened enlarged epididymis with increased Doppler wave pulsation represents epididymitis.
    • The accuracy of the emergency physician to diagnose acute scrotal pain is being studied. See Under Investigation.

Procedures

  • Scrotal exploration or aspiration of epididymis (rarely needed and performed by a urologist)

More on Epididymitis

Overview: Epididymitis
Differential Diagnoses & Workup: Epididymitis
Treatment & Medication: Epididymitis
Follow-up: Epididymitis
References
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References

  1. Blaivas M, Sierzenski P, Lambert M. Emergency evaluation of patients presenting with acute scrotum using bedside ultrasonography. Acad Emerg Med. Jan 2001;8(1):90-3. [Medline].

  2. Asgari SA, Mokhtari G, Falahatkar S, Mansour-Ghanaei M, Roshani A, Zare A. Diagnostic accuracy of C-reactive protein and erythrocyte sedimentation rate in patients with acute scrotum. Urol J. 2006;3(2):103-7. [Medline].

  3. Harwood-Nuss AL, Etheredge W, McKenna I. Urologic Emergencies. Emergency Medicine Concepts and Clinical Practice. 1998;Vol 3:2241-2243.

  4. Schneider RE. Male genital problems. In: Tintinalli JE, et al, eds. Emergency Medicine: A Comprehensive Study Guide. 4th ed. McGraw Hill Text; 1996:536-537.

  5. Cappèle O, Liard A, Barret E, Bachy B, Mitrofanoff P. Epididymitis in children: is further investigation necessary after the first episode?. Eur Urol. Nov 2000;38(5):627-30. [Medline].

  6. Knowles DR. Epididymitis. Last updated August 26, 2006. Available from: MedlinePlus. Available at www.nlm.nih.gov/medlineplus/ency/article/001279.htm.

  7. Trei JS, Canas LC, Gould PL. Reproductive tract complications associated with Chlamydia trachomatis infection in US Air Force males within 4 years of testing. Sex Transm Dis. Sep 2008;35(9):827-33. [Medline].

  8. Nusbaum MR, Wallace RR, Slatt LM, Kondrad EC. Sexually transmitted infections and increased risk of co-infection with human immunodeficiency virus. J Am Osteopath Assoc. Dec 2004;104(12):527-35. [Medline].

  9. Centers for Disease Control and Prevention. Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. Apr 13 2007;56(14):332-6. [Medline]. [Full Text].

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  11. Drury NE, Dyer JP, Breitenfeldt N, Adamson AS, Harrison GS. Management of acute epididymitis: are European guidelines being followed?. Eur Urol. Oct 2004;46(4):522-4; discussion 524-5. [Medline].

  12. Galejs LE. Diagnosis and treatment of the acute scrotum. Am Fam Physician. Feb 15 1999;59(4):817-24. [Medline].

  13. Haidl G, Allam JP, Schuppe HC. Chronic epididymitis: impact on semen parameters and therapeutic options. Andrologia. Apr 2008;40(2):92-6. [Medline].

  14. Joly-Guillou ML, Lasry S. Practical recommendations for the drug treatment of bacterial infections of the male genital tract including urethritis, epididymitis and prostatitis. Drugs. May 1999;57(5):743-50. [Medline].

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  16. National Guideline Clearinghouse. Epididymitis. Sexually transmitted diseases guidelines 2006. 2006. Center for Disease Control and Prevention; August 4, 2006. [Full Text].

  17. Novella G, Porcaro AB, Righetti R, Cavalleri S, Beltrami P, Ficarra V. Primary lymphoma of the epididymis: case report and review of the literature. Urol Int. 2001;67(1):97-9. [Medline].

  18. Peterson NE. Common urologic emergencies: a logical and practical approach to rapid diagnosis and treatment. Emerg Med Rep. 1994;15:16.

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  20. Schwab R. Acute scrotal pain requires quick thinking and plan of action. Emerg Med Rep. 1992;13:2.

  21. Somekh E, Gorenstein A, Serour F. Acute epididymitis in boys: evidence of a post-infectious etiology. J Urol. Jan 2004;171(1):391-4; discussion 394. [Medline].

  22. Swartz D. Acute scrotal mass. In: Harwood-Nuss A, Linden CH, eds. The Clinical Practice of Emergency Medicine. 2nd ed. Lippincott Williams & Wilkins Publishers; 1996:270-272.

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Further Reading

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Keywords

epididymitis, epididymo-orchitis, intrascrotal inflammation, Escherichia coli, Chlamydia trachomatis, Neisseria gonorrhoeae, chemical epididymitis, epididymal abscess, testicular abscess, sterility, peritubular fibrosis, sexually transmitted epididymitis, urethritis, scrotal pain, scrotal edema, urinary frequency, urinary urgency, dysuria, urinary retention, urethral discharge, scrotal abscess, Prehn sign, candidal epididymitis

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Contributor Information and Disclosures

Author

Catherine Tubridy, MD, Staff Physician, Combined Residency Program for Emergency Medicine and Internal Medicine, State University of New York Downstate/Kings County Hospital Centers
Catherine Tubridy, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Coauthor(s)

Richard Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Richard Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Robert M McNamara, MD, FAAEM, Chair and Professor, Department of Emergency Medicine, Temple University School of Medicine
Robert M McNamara, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Pennsylvania Medical Society, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Richard Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Program Director, Professor, Department of Emergency Medicine, Professor, Internal Medicine, University Hospitals, Case Western Reserve School of Medicine
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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