eMedicine Specialties > Emergency Medicine > Genitourinary

Epididymitis: Follow-up

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

Follow-up

Further Inpatient Care

  • Most cases of epididymitis can be managed on an outpatient basis. However, admit the patient for parenteral therapy if any of the following are present:
    • Intractable pain
    • Nausea or vomiting that interferes with oral therapy
    • Clinical evidence of an abscess or when an abscess cannot be ruled out
    • Signs of toxicity or possible sepsis
    • Failure to improve during initial 72 hours of outpatient management
    • Immunocompromised patient with significant signs or symptoms

Further Outpatient Care

  • Initiate treatment as discussed above.
  • The patient must be evaluated by a urologist within 3-7 days of presentation. This follow-up is mandatory, as a testicular tumor occasionally is the true cause of the symptoms.7
  • The patient must receive detailed instructions for treatment, including reasons for immediate return.
  • Patients with epididymitis secondary to a potential sexually transmitted disease and all of their sexual contacts need referrals in order to screen and diagnose all comorbid STDs, to include HIV.
  • In pediatric patients with no prior urological history and in the absence of bacteriuria, one retrospective study suggests that investigation for underlying urinary tract pathology should be carried out after the second episode.5

Deterrence/Prevention

  • When treating epididymitis secondary to C trachomatis or N gonorrhoeae, treatment of all sexual partners is necessary in order to limit the rate of recurrence and to achieve maximal cure rates.
  • Reinforce the advisability of condom use in the prevention of disease.

Complications

Complications of epididymitis may include the following:

  • Infertility
  • Scrotal abscess formation
  • Epididymo-orchitis
  • Sepsis
  • Fournier gangrene (necrotizing synergistic infection)

Prognosis

  • Pain improves within 1-3 days, but induration may take several weeks or months to resolve.
  • Sterility may result from bilateral involvement.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • One must have a high index of suspicion for testicular torsion when evaluating patients with acute testicular or scrotal pain.
  • The most common misdiagnosis for testicular torsion is epididymitis. Often, this results from reliance on imperfect diagnostic tests over clinical judgment. Surgical exploration to definitively exclude torsion is not a high-risk procedure. Insist on rapid, in person, consultation by the urologist in suspect cases.
  • Admit patients with signs of significant systemic toxicity to the hospital for parenteral therapy.
  • All patients discharged with a diagnosis of epididymitis require follow-up in order to be certain a testicular tumor is not the cause of the symptoms.
  • Evaluation or referral regarding syphilis and HIV infection often is neglected in cases with a sexually transmitted cause.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Michael B Brooks, MD, to the development and writing of this article.



More on Epididymitis

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

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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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