Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Epididymitis and Orchitis

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In one line

·Bacteria climb backward from the urethra or bladder into the epididymis (the tightly coiled tube behind each testicle that stores and matures sperm), causing infection and swelling.

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Normal physiology

·The epididymis is a long, tightly coiled tube—about 20 feet if you stretched it out—sitting like a cap on the back of each testicle. Its job is to store sperm made in the testicle and finish maturing them so they can swim and fertilize an egg.

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What goes wrong

·Bacteria climb backward from the urethra or bladder, travel up the vas deferens, and invade the epididymis, causing infection and swelling.

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Hallmark signs

·Pain and swelling in one testicle or the back part of the testicle
·The scrotum feels warm and looks red
·Pain when you pee or a frequent urge to pee
·Discharge (fluid dripping) from the penis
·Fever and chills
·Tenderness in the lower belly or pelvis
·A lump or firmness you can feel in the testicle
·Blood in the semen

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Red flags · escalate now

·Sudden, severe testicle pain that comes on in minutes — may be testicular torsion (the testicle twisted on its cord and is losing blood supply), a surgical emergency.
·Fever above 101°F (38.3°C) with shaking chills — suggests infection is spreading into the bloodstream or forming an abscess (a pocket of pus).
·Unable to pee or very little urine comes out — may mean severe swelling is blocking the urethra or infection has spread to the bladder and kidneys.
·Testicle feels extremely hard, does not get better with antibiotics after 48 hours, or you see pus draining from the scrotum — may be an abscess that needs draining or a different diagnosis like cancer.
·Nausea, vomiting, or confusion along with testicle pain and fever — signs the infection may be severe (sepsis, meaning bacteria in the blood poisoning the whole body) and affecting your organs.

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Workup

·Urinalysis with microscopy
·Urine culture and sensitivity
·Nucleic acid amplification test (NAAT) for Chlamydia trachomatis and Neisseria gonorrhoeae on first-catch urine or urethral swab
·Scrotal ultrasound with Doppler (sound waves that show blood flow)
·Complete blood count (CBC)
·Blood cultures (if fever ≥ 101.5°F or 38.6°C, shaking chills, or signs the infection is spreading through the body)
·Sexually transmitted infection (STI) panel including HIV and syphilis (if chlamydia or gonorrhea is found)
·Post-void residual urine measurement (ultrasound or catheter after the patient pees)

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Treatment

·Ceftriaxone 500 mg intramuscular (IM) shot once PLUS doxycycline 100 mg by mouth twice daily for 10 days (if under 35 or sexually transmitted infection suspected)
·Levofloxacin 500 mg by mouth once daily for 10 days (if over 35 or bladder bacteria suspected and local resistance < 10%)
·Nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen 400–600 mg by mouth three times daily with food
·Scrotal elevation and support (athletic supporter, jock strap, rolled towel, or pillow under the scrotum when lying down)
·Partner notification, testing, and treatment (if sexually transmitted pathogen found)
·Hospital admission for IV antibiotics and possible surgical drainage (if fever > 101.5°F or 38.6°C, abscess pocket seen on ultrasound, or no improvement after 48–72 hours of oral antibiotics)
·Urologic follow-up and imaging to check for structural problems (if infection keeps coming back, or if patient is over 35 with no clear cause)

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NCLEX trap

·Always check Prehn sign in epididymitis: gently lifting the scrotum eases the pain and proves the problem is infection in the epididymis (the coiled tube behind the testicle that stores sperm), not a twisted blood vessel. In testicular torsion, the pain gets worse when you lift — that is how you tell them apart at the bedside.
·In epididymitis under age 35, use ceftriaxone 500 mg IM once plus doxycycline 100 mg twice daily for 10 days to cover chlamydia and gonorrhea — fluoroquinolones miss these bugs. Age tells you the likely germ; the germ tells you which antibiotic to use.
·Check urine culture and consider scrotal ultrasound if epididymitis pain does not improve within 3 days on antibiotics — an abscess (a pocket of pus) needs drainage, not just pills. Missing an abscess means the patient gets sicker and may need surgery later.
·In epididymitis, antibiotics kill the bacteria, but the patient still hurts from swelling. Add ibuprofen or naproxen and tell him to wear a scrotal support or gently lift the area — that eases pain and gives antibiotics time to work.
·In epididymitis over age 35, coliform bacteria like E. coli (a gut germ that can climb into the urinary tract) from the bladder are the usual cause — ask about obstruction, enlarged prostate, or recent urinary procedures. These men need different antibiotics (levofloxacin or trimethoprim-sulfamethoxazole) and a urology workup to find why bacteria are flowing backward.
·In epididymitis from sexually transmitted bugs (under 35), always tell the patient and his partner to get checked and treated — untreated partners will reinfect him or spread the germ to others. This is public health care, not just one patient's care.

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