EPIDIDYMITIS
Epididymitis is an infection of the epididymis [which spreads from the urethra or bladder to the epididymis by way of the ejaculatory duct and vas diferens)
Etiology & Pathophysiology
Occurs as a complication of UTI, urethral stricture disease, bacterial prostatitis gonococcal/non gonococcal urethritis.
In men under 35 sexually transmitted organisms are the main etiologic agents, usually C trachomatis and N. gonorrhoeae.
[In homosexual men, E. coli is a common cause. In older men, the main causes are bladder outlet obstruction and urinary bacteria (e, coli, P. aeroginosa)]
Clinical Manifestations
1. Unilateral scrotal pain and tenderness.
2. Edema, redness and tenderness of scrotum.
3. Dysuria, frequency
4. Fever, nausea, vomiting.
5. Pyuria, bacteriuria, leukocytosis.
Diagnostic Evaluation
1. Examination (grams stain, culture) of initial and midstream urine sample to detect bacteria.
2. Examination (grams stain, culture, gonorrhoea and chlamydia testing) of urethral discharge and expressed prostatic secretions to establish causative organism.
Medical Management
1. Antimicrobial therapy after collection of specimens
[a. Treatment of choice for presumed ST infection is combination of Ceftriaxone (Roceplin) 250mg IM in a single dose with doxycycline 100 mg orally twice a day for 10 days.
b. For presumed E.coli and other infections a quinolone such as Ofloxacin (floxin) 300mg orally twice a day for 10 days is recommended]
2. Analgesics for pain relief.
3. Bed rest with the scrotum elevated on a towel to allow for lymphatic drainage.
4. In some cases, the spermatic cord is injected with a local anaesthetic to relieve pain.
5. An epididymectomy (excision of the epididymis from the testis) may be performed for patients with recurrent, [incapacitating) episodes or for those with chronic, painful conditions.
Complications
1. Spread of infection to testicle – epididymo-orchitis.
2. Infertility [risk, is greater when bilateral infection.
Nursing Interventions
1. Administer or teach self-administration of analgesics as ordered [often NSAIDs or acetaminophen (Tylenol)].
2. Encourage bed rest during the acute phase.
3. Apply scrotal support to relieve edema and discomfort to improve lymphatic drainage and to take tension off the spermatic cord.
a. Use roll towel under scrotum or scrotal bridge.
b. Suggest a cotton-lined athletic supporter for acceleration.
4. Intermittent cold compresses to the scrotum may help ease pain.
5. Local heat or sitz baths later in the infection may hasten resolving of the inflammatory process.
6. Instruct patient
a. To avoid straining (lifting, straining at stool and sexual activity) until infection is under control.
b. Sexual partners within the past 60 days of patient with chlamydial or gonococcal urethritis or epididymitis should be examined and treated.
c. Follow up with health care provider as directed [it may take 2-4 weeks or longer for epididymitis to completely resolve.]
d. Report signs of infection in the reproductive tract immediately to obtain treatment and prevent spread.
e. [Use safer sex practices such as abstinence, mutual monogamy and condoms to prevent further infection associated with sexual activity.]
