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Acute epididymitis

Last reviewed: 19 Aug 2025
Last updated: 14 May 2025

Summary

Definition

History and exam

Key diagnostic factors

  • age >19 years
  • unilateral scrotal pain and swelling of gradual onset
  • symptoms <6 weeks' duration
  • tenderness
  • hot, erythematous, swollen hemiscrotum
  • frequent and painful micturition
  • purulent urethral discharge
Full details

Other diagnostic factors

  • pyrexia
  • fluctuant swelling or induration of scrotal tissue
  • enlarged or tender prostate
Full details

Risk factors

  • unprotected sexual intercourse
  • bladder outflow obstruction
  • instrumentation of urinary tract
  • immunosuppression
  • vasculitis
  • amiodarone
  • mumps
  • exposure to tuberculosis (TB)
Full details

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 Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium
  • culture of urethral secretions
Full details

Investigations to consider

  • scrotal color duplex ultrasonography
  • surgical exploration
  • 3 early morning urine samples for acid-fast bacilli staining, culture, and NAAT for Mycobacterium tuberculosis
  • HIV test
  • syphilis test
Full details

Treatment algorithm

ACUTE

bacterial infection

amiodarone-induced

underlying vasculitis

idiopathic or viral

tuberculous

Contributors

Authors

Ameeta E. Singh, BMBS(UK), MSc, FRCPC, FIDSA

Clinical Professor

Division of Infectious Diseases

University of Alberta

Edmonton

Canada

გაფრთხილება:

AES declares that she has no competing interests.

მადლიერება

Dr Ameeta E. Singh would like to gratefully acknowledge Dr Hossein Sadeghi-Nejad, Dr Lorenzo DiGiorgio, Dr Mary Garthwaite, and Dr Ian Eardley, previous contributors to this topic.

გაფრთხილება:

HSN, LDG, and MG declare that they have no competing interests. IE is a consultant to Pfizer, Lilly, and Sanofi. He is a speaker for Lilly.

რეცენზენტები

Sheldon Morris, MD, MPH

Assistant Professor

Division of Infectious Diseases

Department of Medicine

UCSD Antiviral Research Center

Division of Family Medicine

Department of Family and Preventive Medicine

UCSD La Jolla Family and Sports Medicine

San Diego

CA

გაფრთხილება:

SM has received research funding support from NIH CHRP, CIRM, and Gilead Sciences. He has financial interests in Impact Biomedicines (now Celgene) and Forty Seven Inc. There is no conflict between these financial interests and any content in this topic.

Altaf Mangera, MBChB (Hons), MD, FRCS (Urol), FEBU

Consultant Urologist

Department of Urology

Royal Hallamshire Hospital

Sheffield

UK

გაფრთხილება:

AM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

წყაროები

ჩვენი მტკიცებულებებისა და სარედაქციო ჯგუფები თანამშრომლობენ საერთაშორისო ექსპერტებსა და რეცენზენტებთან, რათა უზრუნველვყოთ თქვენი წვდომა კლინიკურად ყველაზე მნიშვნელოვან ინფორმაციაზე.

ძირითადი სტატიები

Chirwa M, Davies O, Castelino S, et al. United Kingdom British association for sexual health and HIV national guideline for the management of epididymo-orchitis, 2020. Int J STD AIDS. 2021 Sep;32(10):884-95.სრული ტექსტი  აბსტრაქტი

American College of Radiology. ACR appropriateness criteria: acute onset of scrotal pain - without trauma, without antecedent mass. 2024 [internet publication].სრული ტექსტი

Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.სრული ტექსტი  აბსტრაქტი

Street EJ, Justice ED, Kopa Z, et al. The 2016 European guideline on the management of epididymo-orchitis. Int J STD AIDS. 2017 Jul;28(8):744-9. აბსტრაქტი

European Association of Urology. Guidelines on urological infections. Mar 2022 [internet publication].სრული ტექსტი

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  • დიფერენციული დიაგნოზები

    • Testicular torsion
    • Acute idiopathic scrotal edema
    • Infected hydrocele
    მეტი დიფერენციული დიაგნოზები
  • გაიდლაინები

    • ACR appropriateness criteria: acute onset of scrotal pain - without trauma, without antecedent mass
    • 2021 European guideline on Mycoplasma genitalium infections
    მეტი გაიდლაინები
  • პაციენტის ბროშურები

    Chlamydia

    Gonorrhea

    მეტი პაციენტის ბროშურები
  • padlock-lockedშედით სისტემაში ან გამოიწერეთ BMJ Best Practice

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