Diagnosis

Acute painful unilateral scrotum. Granulomatous epididymitis is not uncommon after BCG (a treatment for bladder cancer) and can get worse with each treatment.

Epidemiologic Risks

Sex, BCG.

Microbiology

Age > 35: coliforms (such as E. coli) or Pseudomonas.

Any age (usually < 35): C. trachomatis and N. gonorrhoeae (I always assume that people over age 35 (being > 50 I will neither confirm nor deny that bias) do not have sex, although the oldest clap I have seen was an 85 yo male. But that was in L.A. And what to do if your age is exactly 35 remains a mystery).

Empiric Therapy

For the elderly, non sexually transmitted, a quinolone pending cultures. For STD's treat accordingly.

Pearls

Rants

ICD9 Codes (Soon to be supplanted by ICD10)

Epididymitis (non-venereal) 604.90; with abscess 604.0; acute 604.99; chlamydial 099.54; gonococcal (acute) 098.0; recurrent 604.99; syphilitic 095.8 ; tuberculous 016.4.