MDM - Epididymitis

[##]-year-old male with history and exam consistent with likely epididymitis.

Initial considerations in this patient included epididymitis, testicular torsion, hematocele, hydrocele, spermatocele, hernias, scrotal abscess, sexually transmitted infections, urinary tract infection (UTI), scrotal abscess and cellulitis, Fournier gangrene, and testicular mass or neoplasm among others.  

Patient presented with report of [testicular/scrotal] pain with associated [dysuria/fever/urinary frequency] and pain on palpation of the epididymitis [relieved with elevation of the testicle (Prehn sign)] suggestive of epididymitis.  [A scrotal ultrasound was obtained due to patient report of testicular pain, and was notable for evidence of epididymitis without findings suggestive of torsion.]  A urinalysis was obtained and [noted to be unremarkable/notable for evidence of pyuria consistent with epididymitis].  In addition, urine tests for gonorrhea and chlamydia were sent with discussion of [follow up with primary care doctor for results of these tests/treatment with antibiotics to cover these organisms prophylactically and recommendation that sexual partners are tested].  

Prior to discharge, we discussed return precautions and discharge with antibiotics to cover [sexually transmitted infections/enteric organisms], and the patient demonstrated understanding and agreement with this plan.

MDM - Sexually Transmitted Infection (Female)

[##-year-old] female presents with [report of sexual contact with reported sexually transmitted infection (STI)/complaint] with history and exam consistent with [specify STI/indications for prophylactic treatment].

Initial considerations in this patient included gonorrhea, chlamydia, syphilis, human immunodeficiency virus (HIV), pelvic inflammatory disease (PID), tubo-ovarian abscess (TOA), pelvic inflammatory disease, genital herpes, and other urinary tract infections (UTI) amongst others.

Patient presents [with/without] report of [a sexual partner with a confirmed diagnosis of gonorrhea/chlamydia/a concerning sexual encounter with unprotected intercourse].  Patient [reports/denies] current symptoms [dysuria/frequency/other].  Testing for gonorrhea and chlamydia was sent on a [urinalysis/cervical swab] obtained in the ED with discussion of appropriate follow up as these tests will not result for several days.  Patient noted to have a negative urine pregnancy test in the ED.  Urinalysis was obtained [with/without] findings suggestive of UTI [additional].  A genital exam was performed [with/without] evidence of vesicular lesions [and/or] other symptoms suggestive of herpes genitalis.  In addition, the patient was noted to have no evidence of chancre on genital exam making syphilis unlikely.  A pregnancy test was obtained in the ED and noted to be [positive/negative].  Doubt PID or TOA at this time given the absence of fever, pelvic pain, purulent vaginal discharge, or other suggestive findings.  After discussion of the risks, benefits, and alternatives to prophylactic treatment with antibiotics in the ED, the patient opted to [start treatment in the ED/defer until results of testing and follow up with his primary care doctor]. 

We discussed limitations of STI testing in the ED, and recommended close follow up with his primary care physician for additional testing to include consideration of HIV testing, and the patient demonstrated understanding and agreement with this plan.

https://www.cdc.gov/std/healthcomm/fact_sheets.htm

MDM - Sexually Transmitted Infection (Male)

[##-year-old] male presents with [report of sexual contact with reported sexually transmitted infection (STI)/complaint] with history and exam consistent with [specify STI/indications for prophylactic treatment].

Initial considerations in this patient included gonorrhea, chlamydia, syphilis, human immunodeficiency virus (HIV), genital herpes, epididymitis, and other urinary tract infections (UTI) amongst others.

Patient presented [with/without] report of [a sexual partner with a confirmed diagnosis of gonorrhea/chlamydia/a concerning sexual encounter with unprotected intercourse].  Patient [reports/denies] current symptoms [dysuria/frequency/other].  Testing for gonorrhea and chlamydia was sent on a [urinalysis/urethral swab] obtained in the ED with discussion of appropriate follow up as these tests will not result for several days.  A genital exam was performed [with/without] evidence of vesicular lesions [and/or] other symptoms suggestive of herpes genitalis.  In addition, the patient was noted to have no evidence of chancre on genital exam making syphilis unlikely.  After discussion of the risks, benefits, and alternatives to prophylactic treatment with antibiotics in the ED, the patient opted to [start treatment in the ED/defer until results of testing and follow up with his primary care doctor]. 

We discussed limitations of STI testing in the ED, and recommended close follow up with his primary care physician for additional testing to include consideration of HIV testing, and the patient demonstrated understanding and agreement with this plan.

https://www.cdc.gov/std/healthcomm/fact_sheets.htm

Discharge Instructions - Prostatitis

As discussed in the Emergency Department prior to discharge, you have been diagnosed with prostatitis.  Prostatitis is an infection or inflammation of the prostate gland.  The prostate gland is only present in men, where it is involved in making some of the fluid men release during sex.  The prostate gland surrounds the urethra (the tube that carries urine out of the penis), which is why prostatitis often causes discomfort with urination.

Prostatitis can be either “acute” or “chronic.”  Acute prostatitis is most commonly caused by bacteria, whereas chronic prostatitis can occur with or without a bacterial infection.  Acute prostatitis can cause fever, chills, flu-like symptoms, muscle pain, painful urination, and cloudy urine.  Chronic prostatitis can cause painful urination, frequent sensation of the need to urinate, feel the need to rush to urinate, or even a low-grade fever.

If you were prescribed antibiotics be sure to complete the full course – do not stop early!  If antibiotics do not resolve your symptoms, you may have chronic prostatitis and you should follow up with your primary care provider.

Return to the Emergency Department for worsening pain, fever (≥38.0 °C or 100.4 °F) after 2 days of antibiotics, inability to pass urine for 6 hours after multiple attempts, or any new or concerning symptoms.

Discharge Instructions - Epididymitis

As discussed in the Emergency Department prior to discharge, you have been diagnosed with epididymitis.  Epididymitis is the term doctors use when the epididymis gets inflamed.  The epididymis is a small structure that sits on top of the testicle.  The epididymis stores sperm and moves it along the male reproductive tract.

Different infections and conditions can cause epididymitis.  In teens and men who are having sex, epididymitis is commonly caused by chlamydia or gonorrhea.  These are 2 different infections that people can catch during sex.

Epididymitis can also be caused by other conditions or infections that people don't catch during sex.  These things are more likely to cause epididymitis in older men.

Epididymitis causes pain in the testicles or scrotum.  Besides pain, epididymitis can also cause swelling of the scrotum or testicles, redness of the scrotum, and fever.

You may have received an antibiotic in the Emergency Department as an injection.  Over the next 6 hours watch the site of this injection for evidence of redness, swelling, or worsening pain.  These may indicate an allergic reaction to the medication given.

You may have been discharged home with antibiotics to treat the infection causing epididymitis.  Be sure to complete the full course of antibiotics – do not stop early.

If you were directed to follow up with your primary care provider for further testing of sexually transmitted infections, it is important that you do this.  The testing done in the Emergency Department for chlamydia and gonorrhea can take up to several weeks to come back, so you will need to follow up with your primary care provider to check results.  These infections can be associated with other sexually transmitted infections, so it is important that you get additional testing done.

To help with the pain and swelling, you can:

-Put a cold gel pack, bag of ice, or bag of frozen vegetables on the area every few hours, for 15 minutes each time.

-Wear a jock strap to support your scrotum.

-Take an over-the-counter medicine to treat your pain.  Over-the-counter medicines include Acetaminophen (Tylenol), Ibuprofen (Advil or Motrin), and Naproxen (Aleve).

Return to the Emergency Department for worsening pain, fever (≥38.0 °C or 100.4 °F) after 2 days of antibiotics, inability to pass urine for 6 hours after multiple attempts, or any new or concerning symptoms.