Acute Epididymitis
Educational assessment guide for adult men
1. What is the patient's age?
Age helps indicate the likely pathogen. Men under 35 are more often affected by sexually transmitted organisms; men 35 and over more often by enteric organisms.
2. Does the patient have any of the following?
These features help identify the likely pathogen group.
3. How did the pain start?
Sudden onset is a red flag for testicular torsion.
4. Does the patient have fever or systemic symptoms?
Fever above 38°C or systemic illness may suggest a more severe infection, orchitis, or abscess.
5. Review and generate summary
This will generate an educational summary of typical investigations and antibiotic options based on your answers.
Produced by Dr. Mohit Sharma, UROWALA
First priority — exclude testicular torsion
Torsion is a surgical emergency. Sudden onset, an absent cremasteric reflex, nausea/vomiting, or a high-riding testis should prompt immediate urgent Doppler ultrasound or surgical exploration without delay. Do not rely on Prehn's sign to exclude torsion — it is unreliable.
Disclaimer
This is guidance, not clinical advice. This tool is an educational aid only — it is not a diagnostic calculator and does not replace clinical assessment or professional medical advice. Please consult a urologist or your treating doctor before any diagnostic or treatment decision. If pain is sudden, severe, or worsening, seek emergency care immediately.
Based on the EAU Guidelines on Urological Infections and the 2024 European Guideline on the Management of Epididymo-orchitis.
Testicular torsion must be excluded
Do not delay. Sudden onset of scrotal pain requires urgent Doppler ultrasound or surgical exploration. Torsion is a surgical emergency — time is critical for testicular salvage.
DiagnosisAcute Epididymitis
Tap for details
Investigations required
Treatment
Enter the access code to reveal antibiotic treatment recommendations.
Incorrect code. Please try again.
Supportive care & follow-up
Partner notification & STI screening
If a sexually transmitted infection is confirmed or suspected, sexual partners require notification and treatment to prevent reinfection and onward transmission.
- Offer HIV, syphilis, and hepatitis B/C screening.
- Advise sexual abstinence until treatment is completed and symptoms resolve.
- Consider a test of cure if symptoms persist.
When to escalate care
Re-evaluate at 48–72 hours. If no improvement or clinical deterioration:
- Repeat scrotal ultrasound to rule out abscess formation.
- Consider urology referral for surgical drainage if an abscess is present.
- Adjust antibiotics based on culture and sensitivity results.
- Consider inpatient IV antibiotics if there is severe systemic illness.