Epididymitis

Case report:

A 18 year old patient comes into practice and complains of existing for a few days significant swelling and pain around the right testis with low-grade fever. At times there would be a purulent urethral pain while urinating. A few days before the onset of symptoms so the patient reports that he had unprotected sex with a prostitute.

Diagnosis:

On physical examination, a marked swelling, tenderness and redness of the moderate right epididymis is striking. Furthermore, there is a slight purulent discharge from the urethra. The rectal examination is unremarkable, the body temperature is slightly increased with 38 � C. In the microscopic examination of Urethralsekretes as well as in bacteriological culture gonococcal be clearly demonstrated. The susceptibility testing results in a good sensitivity aufPenicillin G and cephalosporins.

Pathogenesis:

Acute bacterial infection of the epididymis with younger patients is usually caused by Neisseria gonorrhoae and / or Chlamydia trachomatis. Very often prove an accompanying urethritis in such infections. Complicating may occur in terms of orchitis even after prolonged non-treatment of the participation of the testicle.

Therapy:

In the present significant swelling and tenderness of the epididymis should be done for a few days of bed rest with elevation and cooling of the testicle. Antibiotic therapy is a combined ausCeftriaxon (Rocephin) 250 to 500 mg in the or i.v. plusDoxycyclin (VIBRAMYCIN etc.) 2 x administered 100 mg daily for eight to ten days. Alternatively Ofloxacin may (Tarivid) are given 2 x 300 mg daily for ten days; this material has the advantage that it is effective against both gonorrhea, chlamydia and also against Gram-negative pathogens. Because of the special history also an inquiry into hepatitis B and a syphilis should be performed.