Diagnostics

• Epididymitis is a clinical diagnosis.

• Urine and urethral studies help tailor antibiotic therapy and identify the causative organism.

• Imaging is primarily used to rule out testicular torsion but can confirm epididymitis if the diagnosis is uncertain.

Testicular torsion is the most important differential diagnosis of epididymitis and must be ruled out firs

• Urinalysis: to identify pyuria and/or bacteriuria

• Urine culture: to identify the causative organism and assess for antibiotic resistance

• Nucleic acid amplification testing (NAAT) for Chlamydia trachomatis and Neisseria gonorrhea (urine sample or urethral swab)

• Gram stain of urethral secretions: to identify urethritis and gonococcal infections

Testing for HIV and syphilis is recommended for all patients with acute epididymitis.

Duplex ultrasound of the scrotum

• May be used to rule out testicular torsion and scrotal abscess

• Findings: An enlarged, hyperemic epididymis with increased blood flow indicates epididymitis.

• Testicular torsion

• Hydrocele

• Varicocele

• Inguinal hernia