Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • age <35 years: more likely to have sexually transmitted infection
  • older man: more likely to have infection with enteric organisms
  • unilateral scrotal pain and swelling of gradual onset
  • symptoms <6 weeks' duration
  • tenderness
  • hot, erythematous, swollen hemiscrotum
  • frequent and painful micturition
  • purulent urethral discharge

Other diagnostic factors

  • pyrexia
  • fluctuant swelling or induration of scrotal tissue

Risk factors

  • unprotected sexual intercourse
  • bladder outflow obstruction
  • instrumentation of urinary tract
  • immunosuppression
  • vasculitis
  • amiodarone
  • mumps
  • exposure to TB

Diagnostic investigations

1st investigations to order

  • Gram stain of urethral secretions
  • urine dipstick test
  • urine microscopy
  • urine culture
  • nucleic acid amplification test (NAAT) of urethral secretions or first-void urine for C trachomatis and N gonorrhoeae
  • culture of urethral secretions
Full details

Investigations to consider

  • colour duplex ultrasonography
  • surgical exploration
  • 3 early morning urines for alcohol- and acid-fast bacilli (AAFB)
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant Urologist

James Cook University Hospital

Middlesbrough

UK

Disclosures

MG declares that she has no competing interests.

Consultant Urologist

St James's University Hospital

Leeds

UK

Disclosures

IE is a consultant to Pzifer, Lilly, and Sanofi. He is a speaker for Lilly.

Peer reviewers VIEW ALL

Consultant Urological Surgeon

Spire Manchester Hospital

Manchester

UK

Disclosures

SP declares that he has no competing interests.

Director

Center for Male Fertility

Glickman Urological and Kidney Institute

Cleveland

OH

Disclosures

ES declares that he has no competing interests.

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