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Cervicitis is characterized by purulent or mucopurulent discharge from the cervix. N. gonorrhoeae and C. trachomatis most commonly cause cervicitis, but in most cases, neither is isolated. Another cause of cervicitis is inflammation in the zone of ectopy, and this should especially be suspected in chronic cases that are resistant to antibiotics.

The CDC recommends antibiotic treatment for cervicitis only if N. gonorrhoeae or C. trachomatis is isolated. However, empiric treatment can be considered in patient populations with a high incidence of infection or in patients who may not return for test results. Treatment regimens are the same as those for urethritis. Test-of-cure is not necessary. Partners should be appropriately notified, and sexual abstinence is recommended until 7 days after completion of therapy.



The epididymis is a convoluted duct on the posterior and superior surfaces of the testes that serves as a reservoir for spermatozoa. Epididymitis is an inflammation of this structure characterized by pain and swelling. Epididymitis can be caused by sterile urinary reflux or by ascending infection. In men younger than 35 years of age, C. trachomatis and N. gonorrhoeae are responsible for most cases. Older men and children are more likely to have infection with the coliform bacteria that cause urinary tract infections. Coliform bacteria may also be the most common pathogen among men who have unprotected anal sex.

Men complaining of a painful epididymis should be questioned about symptoms of urethritis, cystitis, and prostatitis. Occasionally, generalized symptoms such as fever and chills may be noted. In epididymitis, swelling and tenderness is typically limited to the epididymis. A very important diagnostic consideration is testicular torsion, which can lead to infarction and loss of the testicle if undiagnosed. Swelling can be limited to the epididymis in early torsion. Prompt ultrasonography is imperative if the diagnosis is in doubt. Color duplex Doppler ultrasonography is very sensitive and specific for both epididymitis and testicular torsion.

Gram stain of urethral discharge and first-void urine for leukocytes can be helpful. Urine culture as well as testing for C. trachomatis and N. gonorrhoeae should also be performed. But antibiotics should be started empirically before the results of these tests are back. Depending on the clinical scenario, treatment is aimed at either coliform bacteria or sexually transmitted organisms. Patients who do not improve within 3 days should be reevaluated. Patients with generalized symptoms sometimes require hospitalization.


Men's Health