**Epididymitis** **Infectious** * E. coli in adults * Chlamydia trachomatis * N. gonorrhea * Mycoplasma genitalium * Ureaplasma urealyticum **Non-Infectious** * Trauma * Autoimmune disease * Idiopathic **Usually chronic > 6 wks** * Excludes tuberculosis **Diagnostics** **Adults <35:** * Urine culture * Gram stain of urethral discharge * Culture, nucleic acid amplification testing (NAATs) for Chlamydia trachomatis, N. gonorrhea **Adults >35:** * Urine culture * Gram stain of urethral discharge * Culture, nucleic acid amplification testing (NAATs) for Chlamydia trachomatis, N. gonorrhea * Scrotal ultrasound **Clinical Features** * Gradual onset * Pain * Swelling * May radiate to lower back/abdomen * Fever/chills * Dysuria * Frequency * Urgency **If testicles involved:** * Epididymo-orchitis **Scrotal skin:** * Red * Shiny * Edema * Tenderness over posterior testis **Prehn's sign:** * Relief with elevation of scrotum **Associated with:** * Behcet's Disease * Granuloma formation in seminiferous tubules **Treatment & Management** * **Meds - Infectious cause** * Anti-microbial therapy * Ceftriaxone, doxycycline - covers C. trachomatis * N. gonorrhea * Ceftriaxone, quinolone for >35 year old * Those who have anal sex * **Surgery** * Performed when findings are equivocal, testicular torsion can't be ruled out * **Other interventions - for both infectious & non-infectious causes** * Rest * Analgesia * Hot or cold packs (for analgesics e.g. NSAIDs) * Scrotum elevation * **Non-infectious** * Tx underlying cause