- Men who have epididymitis typically have unilateral testicular pain and tenderness; hydrocele and palpable swelling of the epididymis usually are present
- Testicular torsion, a surgical emergency, should be considered in all cases, but it occurs more frequently among adolescents and in men without evidence of inflammation or infection
- Emergency testing for torsion may be indicated when the onset of pain is sudden, pain is severe, or the test results available during the initial examination do not support a diagnosis of urethritis or urinary-tract infection
- If the diagnosis is questionable, a specialist should be consulted immediately, because testicular viability may be compromised
- The evaluation of men for epididymitis should include the following procedures.
- A Gram-stained smear of urethral exudate or intraurethral swab specimen for diagnosis of urethritis (i.e., >5 polymorphonuclear leukocytes per oil immersion field) and for presumptive diagnosis of gonococcal infection
- A culture of intraurethral exudate or a nucleic acid amplification test (either on intraurethral swab or first-void urine) for N. gonorrhoeae and C. trachomatis
- Examination of first-void uncentrifuged urine for leukocytes if the urethral Gram stain is negative. A culture and Gram-stained smear of this urine specimen should be obtained.
- Syphilis serology and HIV counseling and testing