Guidelines for the Management of Sexually Transmitted Infections. February 2004
(2004; 88 pages)
Table of Contents
View the documentPREFACE
Open this folder and view contents1. INTRODUCTION
Close this folder2. TREATMENT OF STI-ASSOCIATED SYNDROMES
Open this folder and view contents2.1. Urethral discharge
Open this folder and view contents2.2. Genital ulcer
View the document2.3. Scrotal swelling
Open this folder and view contents2.4. Vaginal discharge
View the document2.5. Lower abdominal pain
View the document2.6. Neonatal conjunctivitis
Open this folder and view contents3. TREATMENT OF SPECIFIC INFECTIONS
Open this folder and view contents4. KEY CONSIDERATIONS UNDERLYING TREATMENTS
Open this folder and view contents5. PRACTICAL CONSIDERATIONS IN STI CASE MANAGEMENT
Open this folder and view contents6. CHILDREN6, ADOLESCENTS AND SEXUALLY TRANSMITTED INFECTIONS
View the documentANNEX. LIST OF PARTICIPANTS
 

2.3. Scrotal swelling

Inflammation of the epididymis (epididymitis) usually manifests itself by acute onset of unilateral testicular pain and swelling, often with tenderness of the epididymis and was deferens and occasionally with erythema and oedema of the overlying skin. In men under 35 years of age this is more frequently due to sexually transmitted organisms than in those over 35 years of age. When the epididymitis is accompanied by urethral discharge, it should be presumed to be of sexually transmitted origin, commonly gonococcal and/or chlamydial in nature. The adjacent testis is often also inflamed (orchitis), giving rise to epididymo-orchitis.

In older men, where there may have been no risk of a sexually transmitted infection other general infections may be responsible, for example, Escherichia coli, Klebsiella spp. or Pseudomonas aeruginosa. A tuberculous orchitis, generally accompanied by an epididymitis, is always secondary to lesions elsewhere, especially in the lungs or bones. In brucellosis, usually due to Brucella melitensis or Brucella abortus, an orchitis is usually clinically more evident than an epididymitis. In pre-pubertal children the usual aetiology is coliform, pseudomonas infection or mumps virus. Mumps epididymo-orchitis is usually noted within a week of parotid enlargement.

It is important to consider other non-infectious causes of scrotal swelling, such as trauma, testicular torsion and tumour. Testicular torsion, which should be suspected when onset of scrotal pain is sudden, is a surgical emergency that needs urgent referral.

If not effectively treated, STI-related epididymitis may lead to infertility.

Recommended syndromic treatment

• therapy for uncomplicated gonorrhoea (for details see section 3.1)

PLUS

• therapy for chlamydia (for details see section 3.2)

AT A GLANCE

Scrotal Swelling

For details, see section 3.1 and 3.2

Drug options for Gonorrhoea

Drug options for Chlamydia

Ciprofloxacin

Doxycycline

Azithromycin

Azithromycin

Ceftriaxone

 

Cefixime

 

Spectinomycin

 

Alternatives

Alternatives

Kanamycin

Amoxicillin

Trimethoprim/Sulfamethoxazole

Ofloxacin

 

Erythromycin (if Tetracycline is contraindicated)

 

Tetracycline

Adjuncts to therapy

Bed rest and scrotal support until local inflammation and fever subside.


FIGURE 5. SCROTAL SWELLING

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