Infections of the urogenital tract (URI)

Acute pyelonephritis Gestational pyelonephritis Recurrent Urinary Tract Infection Complicated URI infection Acute cystitis Urinary catheterization Acute prostatitis Chronic Prostatitis Epididymitis Mumps orchitisn Primary syphilis Salpingitis Vaginitis

Epididymitis

Case report:

A 18 year old patient comes into practice and complains of existing for a few days significant swelling and pain around the right testis with low-grade fever. At times there would be a purulent urethral pain while urinating. A few days before the onset of symptoms so the patient reports that he had unprotected sex with a prostitute.

Diagnosis:

On physical examination, a marked swelling, tenderness and redness of the moderate right epididymis is striking. Furthermore, there is a slight purulent discharge from the urethra. The rectal examination is unremarkable, the body temperature is slightly increased with 38 C. In the microscopic examination of Urethralsekretes as well as in bacteriological culture gonococcal be clearly demonstrated. The susceptibility testing results in a good sensitivity aufPenicillin G and cephalosporins.

Pathogenesis:

Acute bacterial infection of the epididymis with younger patients is usually caused by Neisseria gonorrhoae and / or Chlamydia trachomatis. Very often prove an accompanying urethritis in such infections. Complicating may occur in terms of orchitis even after prolonged non-treatment of the participation of the testicle.

Therapy:

In the present significant swelling and tenderness of the epididymis should be done for a few days of bed rest with elevation and cooling of the testicle. Antibiotic therapy is a combined ausCeftriaxon (Rocephin) 250 to 500 mg in the or i.v. plusDoxycyclin (VIBRAMYCIN etc.) 2 x administered 100 mg daily for eight to ten days. Alternatively Ofloxacin may (Tarivid) are given 2 x 300 mg daily for ten days; this material has the advantage that it is effective against both gonorrhea, chlamydia and also against Gram-negative pathogens. Because of the special history also an inquiry into hepatitis B and a syphilis should be performed.

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