Cause: Not always infectious, but infectious agents correlate with age of pt

Epidem: Rare < 18 yr of age; peak incidence at 32 yr of age. Perhaps increased risk with intact foreskin (J Urol 1998;160:1842).

Pathophys: Considered an STD in those young, reflux of infected urine if Gram-negative bacteria implicated; testes is spared. Considered a malfunction of the genitourinary tract in those ≤ 18 yr of age.

Sx: Gradual pain onset, with the possibility of first symptom coincident with minor trauma; nausea; dysfunctional voiding characteristics.

Si: Swollen and tender epididymis with normal testicle; Prehn’s sign is neg (relief with elevation of testicle).

Crs: May last 7-10 d with rx.

Cmplc: Chronic epididymitis—consider non-infectious etiology (chemical inflammation from urine reflux); consider prostatitis or urethral
obstruction of some degree in those > 40 yr of age; orchitis; abscess; rarely infarction (Acad Emerg Med 1998;5:1128).

Diff Dx: Testicular torsion; appendix testes torsion; symptomatic varicocele (Prehn’s sign is positive—elevate the testicle and symptomatic relief); neoplasm.

Lab: UA; urine culture and sensitivity; do penile swab first for gc and chlamydia, if STD suspected.

Less than 19 yr of age (J Urol 1995;154:762):