Epididymitis

Young men (<40 years) or multiple sexual partners

Epididymitis can be confused with torsion, and this should be considered. If torsion cannot be confidently excluded, refer as an emergency.

Otherwise, cases without systemic symptoms can be treated with antibiotics, after urine culture is taken. A combination of ciprofloxacin and doxycycline is usually indicated. All patients should be referred to a sexual health physician for STD screening. If symptoms persist, refer to a urologist.

If the patient is systemically unwell, urgent urological referral is needed.

Men over 40 years without multiple sexual partners.

In older men, testicular torsion if rare, but still possible.

Generally, treat as for men <40 years. Sexually transmitted infection is rare in this group, but should still be considered if the history suggests.

For these men, and in any with a positive UTI, urological referral should be made after treatment for investigation of the upper and lower urinary tracts.

Other rare causes of epididymal inflammation to consider:

• Post-TURP (or other BPH surgery) epididymitis
• Epididymal engorgement following vasectomy
• Amiodarone treatment
• Mumps epididymitis (usually presents 7-10 days after parotid swelling)
• TB epididymitis