Last reviewed: June 2018
Last updated: June  2018

Summary

Definition

History and exam

Key diagnostic 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

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

Treatment algorithm

Contributors

Authors VIEW ALL

Professor of Surgery / Urology

Rutgers New Jersey Medical School

Newark

Chief of Urology

New Jersey Veterans Affairs Hospitals

Director of the Center for Male Reproductive Medicine

Hackensack University Medical Center

Hackensack

NJ

Disclosures

HSN declares that he has no competing interests.

Urologist

Division of Urology

Rutgers New Jersey Medical School

Newark

NJ

Disclosures

LDG declares that he has no competing interests.

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

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.

Use of this content is subject to our disclaimer