Epididymitis, Testicle Infection

A 24 year old male, single, sexually active, complained of pain in the right testicle with associated low grade fever of 1 day duration. He said that it was painful when touched with a heavy sensation in the testicle area he also noted that the right is slightly larger than the left testicle.

There is no past medical history of mumps, urinary tract infection and denies previous sexually transmitted disease. Patient have no history of trauma to the groin , and is not engaged in biking or other physical athletic activity.

The patient was diagnosed with Epididymitis and was given Azythromycin 1 gram as single dose and Cefuroxime 200mg Cap, 2 capsules as single dose. Bed rest was also advised as well as elevation and applying ice pack to the affected area.

Epididymitis is a condition wherein there is inflamation of the epididymis or the tube that connects the testicle with the vas deferens. Pathophysiology usually involves ascending infection via vas deferens from prostatic urethra. It usually starts with a low grade fever with associated chills and a feeling of heaviness in the testicular area. Patient usually complains of sensitivity to pressure in the area. Other symptoms may include a mass or lump in the testicle, pain during urination and also ejaculation, blood in the semen, scrotal swelling and urethral discharge.

Physical examination may reveal a red, tender mass on the affected side of the scrotum. Usually there is pain and tenderness in a small area of the testicle where the epididymis is attached. Enlarged lymph nodes in the groin is usually noted. Digital rectal exam may show enlarged and tender prostate.

The most common infectious causes are Escherichia coli, Neisseria gonorrhoea, Chlamydia trachomatis.

General risk includes prolonged sitting, strenuous exercise like biking or motorcycle riding, and also sexual activity.

Laboratory test that may be performed includes urinalysis and if necessary urine culture, complete blood count, doppler ultrasound and STD testing.

image from A.D.A.M

Gonococcal Urethritis , Tulo

A 30 year old male, married, taxi driver came to the clinic complaining of pain with urination and noticeable increase in frequency of 3 days duration. He also noted a yellowish green copious penile discharge that often leaves stain in his underwear. He also said that he had a slight fever and took Paracetamol 500mg which relieved the symptom. On further prodding , the patient volunteered that he had unprotected sex with a sex worker in a bar in Pasay City a week prior to consultation.
History,laboratory and physical examination points to a diagnosis of Urethritis, most probably Gonococcal(Tulo),Gonorrhea, in etiology. Patient was given Azythromycin 1gm as a single dose together with Cefixime 200mg, 2 tablets as single dose. Patient was also advised to increase fluid intake and to practice safe sex in the future.
Gonococcal Urethritis, Tulo, is a sexually transmitted disease with an incubation period of 2-7 days, that causes urinary symptoms like frequency,urgency and dysuria.Almost always there is a copious ,green, yellow urethral discharge that often leaves a mark in the underwear thus the local term "Tulo" or drip . The penile opening or meatus and the anterior urethra may also be inflammed thus a patient may experience a burning sensation with the passage of urine.
Gonorrhea also called the clap, which is caused by Neisseria gonorrhoeae, is an important public health problem and is the most common reportable infectious disease. Gonorrhea is most frequently spread during sexual contact. The most common local complication of gonorrhea in men is Epididymitis which causes unilateral testticular pain and swelling, and epididymal tenderness. Urethral dischage may or may not be present.




(image courtesy www.cdc.gov)

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