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Epididymitis/Orchitis, Emergency Medicine

Reviewed 06/2017




  • Definition: Inflammation or infection of the epididymis

  • Rare in prepubertal boys

  • Pathogenesis:

    • Initial stages:

      • Cellular inflammation begins in vas deferens, descends to epidi...


Signs and Symptoms


  • Gradual onset of mild to moderate testicular or scrotal pain, usually unilateral

  • Progressive scrotal swelling

  • Dysuria (30%):

    • Recent UTI

    • History of abnormal bladder funct...



  • IV access

  • IV fluids, especially if systemically ill

Initial Stabilization/Therapy

  • IV access

  • IV fluids, especially if systemically ill

Ed Treatment/Procedures

  • Antibiotics:

    • Cover for chla...



Admission Criteria

  • Surgical indications present

  • Older age group if it is the only way to ensure appropriate workup:

    • Many will have underlying urologic pathology.

  • Systemically ill, fev...

Pearls and Pitfalls

  • Testicular torsion should be ruled out in all cases of new-onset testicular pain.

  • Epididymitis usually due to STD in sexually active men <35 yr

  • Epididymitis usually due to colifor...

Additional Reading

  • Brenner  JS, Ojo  A. Causes of scrotal pain in children and adolescents. UpToDate. Available at Accessed on January 30, 2013.

  • Ching  CB, Sabanegh  ES. Epididymitis....



  • 604.90 Orchitis and epididymitis, unspecified

  • 604.91 Orchitis and epididymitis in diseases classified elsewhere

  • 604.99 Other orchitis, epididymitis, and epididymo-orchitis, without mention of ...

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