What are the guideline sources, guidelines and references for Acute epididymitis ?
Guideline sources The following summarized guidelines for the evaluation and management of acute epididymitis are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2022), the Center for Disease Control (CDC 2021), the International Union Against Sexually Transmitted Infections (IUSTI 2017), and the American Association of Family Physicians (AAFP 2016). 1 2 3 4 4 4 5 5 Definition Acute epididymitis is the acute inflammation of the epididymis characterized by pain and scrotal swelling present for < 6 weeks. 4 Epidemiology Acute epididymitis is caused by a bacterial ascent (UTIs or STIs), viral genesis (adenovirus, enterovirus), fungi (C. albicans, Histoplasma capsulatum), parasites (Trichomonas vaginalis, Schistosoma species, Filariasis), drug-induced (amiodaron), rheumatic (Beh et's disease, vasculitis, Henoch-Sch nlein purpura), obstruction (vasectomy), genital trauma, and sterile reflux. 5 Disease course https://web.pathway.md/diseases/reczx4WxHw93aZE2V 1/5 6/23/23, 1:38 AM Acute epididymitis Pathway Disease course The inflammation of the epididymis results in acute epididymis, which causes clinical manifestations of gradual unilateral scrotal pain and epididymal swelling with concurrent symptoms of fever, hematuria, dysuria, and urinary frequency. Disease progression may lead to abscess formation or Fournier gangrene, infertility, and chronic pain. 4 Prognosis and risk of recurrence Acute epididymis is not associated with an increase in mortality. 5 Guidelines 1. Screening and diagnosis Clinical presentation: Recognize that: acute epididymitis is characterized by pain, swelling, and inflammation of the epididymis lasting < 6 weeks sometimes a testicle is also involved, a condition referred to as epididymo-orchitis acute epididymitis can be caused by STIs (such as Chlamydia trachomatis, Neisseria gonorrhoeae, or Mycoplasma genitalium) or enteric organisms (such as E. coli) acute epididymitis caused by STIs is usually accompanied by urethritis, which is frequently asymptomatic acute epididymitis caused by sexually transmitted enteric organisms might also occur in males who are the insertive partner during anal sex nonsexually transmitted acute epididymitis caused by genitourinary pathogens typically occurs with bacteriuria secondary to bladder outlet obstruction (such as benign prostatic hyperplasia) nonsexually transmitted acute epididymitis in older males is also associated with prostate biopsy, urinary tract instrumentation or surgery, systemic disease, or immunosuppression. E Recognize that: chronic epididymitis is characterized by a 6-week history of symptoms of discomfort or pain in the scrotum, testicle, or epididymis chronic infectious epididymitis is most frequently observed with conditions associated with a granulomatous reaction, with Mycobacterium tuberculosis as the most common granulomatous disease affecting the epididymis, especially in patients with a known history of or recent exposure to tuberculosis the differential diagnosis of chronic noninfectious epididymitis, sometimes termed orchialgia or epididymalgia, is broad (including trauma, cancer, autoimmune conditions, or idiopathic conditions). E Differential diagnosis: Suspect spermatic cord (testicular) torsion in patients with a sudden onset of symptoms associated with epididymitis, especially in adolescents and patients without evidence of https://web.pathway.md/diseases/reczx4WxHw93aZE2V 2/5 6/23/23, 1:38 AM Acute epididymitis Pathway inflammation or infection. E Refer patients with severe unilateral pain with sudden onset and test results not supporting a diagnosis of urethritis or UTI, or if the diagnosis of acute epididymitis is questionable, immediately to a urologist for evaluation for testicular torsion. E 2. Diagnostic investigations Urine tests: As per EAU 2022 guidelines, obtain a midstream urine and a first-voided urine sample for pathogen identification by culture and NAAT. A As per CDC 2021 guidelines, obtain any of the following point-of-care tests in all patients with suspected acute epididymitis: gram, methylene blue, or gentian violet stain of urethral secretions to demonstrate 2 WBCs/oil immersion field (preferred for evaluating urethritis to document both urethral inflammation and presence or absence of gonococcal infection; establish gonococcal infection by documenting the presence of WBC-containing intracellular Gram-negative or purple diplococci on urethral Gram, methylene blue, or gentian violet stain, respectively) leukocyte esterase test on first-void urine microscopic examination of sediment from a spun first-void urine to demonstrate 10 WBCs/hpf. E Show 2 more Scrotal ultrasound: obtain scrotal ultrasound in patients with suspected testicular torsion and in patients with scrotal pain failed to receive an accurate diagnosis by history, physical examination, and objective laboratory findings. E Screening for other sexually transmitted infections: screen for human immunodeficiency virus and syphilis in all patients with acute epididymitis. E 3. Medical management Setting of care: Treat the majority of patients with acute epididymitis on an outpatient basis. E Refer patients to a specialist and consider admitting to the hospital in case of severe pain or fever indicating other diagnoses (such as torsion, testicular infarction, abscess, or necrotizing fasciitis) or when patients are unable to comply with an antimicrobial treatment. E Antibiotic therapy: As per EAU 2022 guidelines, initiate a single antibiotic or a combination of two antibiotics active against Chlamydia trachomatis and Enterobacterales as initial treatment in young sexually active patients. Consider initiating antibiotics only against Enterobacterales in older patients without sexual risk factors. A Show 2 more https://web.pathway.md/diseases/reczx4WxHw93aZE2V 3/5 6/23/23, 1:38 AM Acute epididymitis Pathway As per CDC 2021 guidelines, initiate presumptive therapy in all sexually active patients at the time of the visit before all laboratory test results are available, to prevent complications and transmission of sexually transmitted. Decide on the choice of regimen based on the risks for chlamydial and gonococcal infections or enteric organisms. E Show 4 more As per IUSTI 2017 guidelines, initiate combination therapy with the following medications as first-line therapy in patients with sexually transmitted epididymo-orchitis: ceftriaxone intramuscularly 500 mg once doxycycline PO 100 mg BID for 10-14 days. B Show 5 more As per AAFP 2016 guidelines, administer intramuscularly ceftriaxone with oral doxycycline if acute epididymitis is thought to be caused by Neisseria gonorrhoeae or Chlamydia trachomatis. B Show 2 more Management of sexual partners: Instruct patients with acute sexually transmitted epididymitis confirmed or suspected to be caused by Neisseria gonorrhoeae or Chlamydia trachomatis to refer all sex partners during the previous 60 days before symptom onset (or the most recent sex partner if the last sexual intercourse was > 60 days before the onset of symptoms or diagnosis) for evaluation, testing, and presumptive treatment. E Instruct partners to abstain from sexual intercourse until they and their sex partners are treated and symptoms have resolved. E 4. Nonpharmacologic interventions Supportive measures: offer bed rest, scrotal elevation, and NSAIDs as an adjunct to antibiotic therapy until fever and local inflammation have subsided. E 5. Patient education General counseling: Counsel patients with acute epididymitis confirmed or suspected to be caused by Neisseria gonorrhoeae or Chlamydia trachomatis to abstain from sexual intercourse until they and their partners have been treated and symptoms have resolved. E Instruct patients to return to their healthcare providers if their symptoms do not improve < 72 hours after treatment. E 6. Follow-up and surveillance Follow-up: https://web.pathway.md/diseases/reczx4WxHw93aZE2V 4/5 6/23/23, 1:38 AM Acute epididymitis Pathway Reevaluate the diagnosis and therapy if signs and symptoms of epididymitis do not subside in < 3 days. E Evaluate for alternative diagnoses (including tumor, abscess, infarction, testicular cancer, tuberculosis, and fungal epididymitis) in patients experiencing swelling and tenderness persisting after completion of antimicrobial therapy. E 7. Quality improvement Reporting: follow national policies on reporting and tracing/treatment of contacts for STIs. A References 1. Emma J Street, Edwin D Justice, Zsolt Kopa et al. The 2016 European guideline on the management of epididymo-orchitis. Int J STD AIDS. 2017 Jul;28 8 744 749. Open 2. Kimberly A Workowski, Laura H Bachmann, Philip A Chan et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70 4 1 187. Open 3. G. Bonkat, R. Bartoletti, F. Bruy re et al. EAU Guidelines on Urological Infections. EAU. 2022. Open 4. McConaghy JR, Panchal B. Epididymitis: An Overview. Am Fam Physician. 2016 Nov 1;94 9 723 726. Open 5. Vera Michel, Adrian Pilatz, Mark P Hedger et al. Epididymitis: revelations at the convergence of clinical and basic sciences. Sep-Oct 2015;17 5 756 63.Sep-Oct 2015;17 5 756 63. Open 6. Suneeta Soni, Paddy Horner, Michael Rayment et al. British Association for Sexual Health and HIV national guideline for the management of infection with Mycoplasma genitalium 2018 . BASHH. 2018. Open https://web.pathway.md/diseases/reczx4WxHw93aZE2V 5/5