Akut Epididimit ve Orşit
Özet
Akut epididimit ve orşit ayaktan tedavi gören skrotal ağrı olgularının en sık nedeni olarak karşımıza çıkmaktadır. Epididimit klinik tablosu, orşitten daha sık görülmektedir. İzole orşit klinik tablosu nadir olmakla birlikte adölesan dönemi öncesi erkek çocuklarında kabakulak enfeksiyonu ile ilişkilidir. En sık olarak 20-39 yaş grubunda görülmektedir. En sık rastlanan patojenler, Chlamydia trachomatis ve Neisseria gonorrhoeae olup diğer yaş gruplarında ise enterik bakteriler birincil patojenlerdir. Cinsel aktivite, epididimit için yaygın bir risk faktörü oluşturmakla birlikte cinsel olarak aktif olmayanlar da risk altındadır. Yaygın olarak cinsel yolla bulaşan bir hastalıkla ilişkili olduğu bildirilmektedir. Epididimit ve orşit klinik tablosu kendini tipik olarak skrotal ağrı ve ateş de dahil olmak üzere alt idrar yolu enfeksiyonu belirtileri ile birlikte kademeli bir başlangıç şeklinde gösterebilir. Tedavi, ampirik antibiyotik verilmesi ile en sık görülen patojenleri hedef almaktadır. Tedavi enfeksiyon ve semptomların iyileştirilmesi, oluşabilecek komplikasyonların azaltılmasına odaklı olmalıdır.
Acute epididymitis and orchitis are the most common causes of scrotal pain in outpatient settings. Epididymitis is more frequently seen than orchitis. Isolated orchitis is rare but is associated with mumps infection in pre-adolescent boys. It is most common in the 20-39 age group. The most common pathogens are Chlamydia trachomatis and Neisseria gonorrhoeae, while enteric bacteria are the primary pathogens in other age groups. Sexual activity is a common risk factor for epididymitis, although those who are not sexually active are also at risk. It is commonly reported to be associated with a sexually transmitted disease. The clinical presentation of epididymitis and orchitis typically presents with a gradual onset, including symptoms of lower urinary tract infection such as scrotal pain and fever. Treatment involves empirical antibiotic therapy targeting the most common pathogens. The focus should be on improving infection and symptoms and reducing future complications.
Referanslar
Louette A, Krahn J, Caine V,et al. Treatment of Acute Epididymitis: A Systematic Review and Discussion of the Implications for Treatment Based on Etiology. Sex Transm Dis. 2018;45(12):e104-e108.
doi: 10.1097/OLQ.0000000000000901.
Rupp TJ, Leslie SW. Epididymitis. 2023 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. https://pubmed.ncbi.nlm.nih.gov/28613565/.
Tıemstra JD, Kapoor S. Evaluation of Scrotal Masses. Am Fam Physician. 2008;78(10):1165-1170.
Çek M, Sturdza L, Pilatz A. Acute and Chronic Epididymitis. Europeanurologysupplements.2017;16(4):124-131. doi:10.1016/j.eursup.2017.01.003.
Tintinalli JE. Emergency Medicine. A Comprehensive Study Guide. Ninth Edition. Section 10. Renal and Genitourinary Disorders. In: Davis JE. Part 93. Male Genital Problems. S:591-597.
Özdemir K, Savaş Ç. Çocuklarda akut skrotal bulguları değerlendirilmesi. SDÜ Tıp Fakültesi Dergisi. 2000;7(4):50-60.
Michel V, Pilatz A, Hedger MP,et al. Epididymitis: revelations at the convergence of clinical and basic sciences. Asian J Androl. 2015 Sep-Oct;17(5):756-63. doi: 10.4103/1008-682X.155770.
Taylor SN. Epididymitis.Clinical Infectious Diseases.2015; 61(8): 770-773.
Bradford R, Farry S, Kyle JA. Antibiotic Therapy for Epididymitis. US Pharmacist. 2015;40(8):39-43.
Nickel JC. Inflammatory and pain conditions of the male genitourinary tract. In: Campbell-Walsh Urology, 11th ed, Wein AJ, Kavoussi LR, Partin AW, et al (Eds), Elsevier 2016. p.331.
Pilatz A, Hossain H, Kaiser R, et al. Acute epididymitis revisited: impact of molecular diagnostics on etiology and contemporary guideline recommendations. Eur Urol 2015;68:428–35.
Banyra O, Shulyak A. Acute epididymo-orchitis: staging and treatment. Cent European J Urol 2012;65:139–43.
Hongo H, Shinojima T, Yazawa S, et al. Development of an algorithm for predicting severe acute epididymitis. J Urol 2014;191:e160.
Tissot S, Perrott C, Grills R. The role of a urine dipstick in the diagnosis of the acute scrotum. BJUI Compass 2022; 3:287.
Gordhan CG, Sadeghi-Nejad H. Scrotal pain: evaluation and management. Korean J Urol. 2015;56(1):3-11.
White JA, Dukers-Muijrers NH, Hoebe CJ,et al. 2025 European guideline on the management of Chlamydia trachomatis infections. Int J STD AIDS. 2025 May;36(6):434-449.
doi: 10.1177/09564624251323678.
Miller JM, Binnicker MJ, Campbell S, et al. A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology. Clin Infect Dis. 2018 Aug 31;67(6):e1-e94. doi: 10.1093/cid/ciy381.
Ludwig M. Diagnosis and therapy of acute prostatitis, epididymitis and orchitis. Andrologia 2008; 40:76–80.
Pepe P, Panella P, Pennisi M, et al. Does color Doppler sonography improve the clinic assessment of patients with acute scrotum? Eur J Radiol 2006; 60:120–4.
Trojian TH, Lishnak TS, Heiman D. Epididymitis and orchitis: an overview. Am Fam Physician 2009; 79:583–7.
Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. Published online July 23, 2021:1-187. doi:10.15585/mmwr.rr7004a1.
Farooq A, Armstrong WS. O'Leary MP, et al. (2025).Acute epididymitis in adolescents and adults. Up To Date. Retrieved January 2026 from https:// www. uptodate.com/ contents/acute-epididymitis-in-adolescents-andadults?Search=acute%20epididimytis&source=search_¬¬ result&selectedTitle=1~150&usage_type=default&display_rank=1.
Lynch S. Acute epididymitis. American Academy of Physician Assistants. 2018;31(3):50-51.
Azmat CE, Vaitla P. Orchitis. 2023 Jun 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. https://pubmed.ncbi.nlm.nih.gov/31985958/.
Wu H, Wang F, Tang D, et al. Mumps Orchitis: Clinical Aspects and Mechanisms.Front.Immunol.2021;12:582946. doi:10.3389/fimmu.2021.582946.
Ludwig M.Diagnosis and therapy of acute prostatitis, epididymitis andorchitis.Andrologia.2008;40(2):76-80.
doi:10.1111/j.14390272. 2007.00823.x.
Bonner M, Sheele JM, Cantillo-Campos S, et al. A Descriptive Analysis of Men Diagnosed With Epididymitis, Orchitis, or Both in the Emergency Department. Cureus. 2021; 13(6): e15800.
doi: 10.7759/cureus.15800.
Referanslar
Louette A, Krahn J, Caine V,et al. Treatment of Acute Epididymitis: A Systematic Review and Discussion of the Implications for Treatment Based on Etiology. Sex Transm Dis. 2018;45(12):e104-e108.
doi: 10.1097/OLQ.0000000000000901.
Rupp TJ, Leslie SW. Epididymitis. 2023 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. https://pubmed.ncbi.nlm.nih.gov/28613565/.
Tıemstra JD, Kapoor S. Evaluation of Scrotal Masses. Am Fam Physician. 2008;78(10):1165-1170.
Çek M, Sturdza L, Pilatz A. Acute and Chronic Epididymitis. Europeanurologysupplements.2017;16(4):124-131. doi:10.1016/j.eursup.2017.01.003.
Tintinalli JE. Emergency Medicine. A Comprehensive Study Guide. Ninth Edition. Section 10. Renal and Genitourinary Disorders. In: Davis JE. Part 93. Male Genital Problems. S:591-597.
Özdemir K, Savaş Ç. Çocuklarda akut skrotal bulguları değerlendirilmesi. SDÜ Tıp Fakültesi Dergisi. 2000;7(4):50-60.
Michel V, Pilatz A, Hedger MP,et al. Epididymitis: revelations at the convergence of clinical and basic sciences. Asian J Androl. 2015 Sep-Oct;17(5):756-63. doi: 10.4103/1008-682X.155770.
Taylor SN. Epididymitis.Clinical Infectious Diseases.2015; 61(8): 770-773.
Bradford R, Farry S, Kyle JA. Antibiotic Therapy for Epididymitis. US Pharmacist. 2015;40(8):39-43.
Nickel JC. Inflammatory and pain conditions of the male genitourinary tract. In: Campbell-Walsh Urology, 11th ed, Wein AJ, Kavoussi LR, Partin AW, et al (Eds), Elsevier 2016. p.331.
Pilatz A, Hossain H, Kaiser R, et al. Acute epididymitis revisited: impact of molecular diagnostics on etiology and contemporary guideline recommendations. Eur Urol 2015;68:428–35.
Banyra O, Shulyak A. Acute epididymo-orchitis: staging and treatment. Cent European J Urol 2012;65:139–43.
Hongo H, Shinojima T, Yazawa S, et al. Development of an algorithm for predicting severe acute epididymitis. J Urol 2014;191:e160.
Tissot S, Perrott C, Grills R. The role of a urine dipstick in the diagnosis of the acute scrotum. BJUI Compass 2022; 3:287.
Gordhan CG, Sadeghi-Nejad H. Scrotal pain: evaluation and management. Korean J Urol. 2015;56(1):3-11.
White JA, Dukers-Muijrers NH, Hoebe CJ,et al. 2025 European guideline on the management of Chlamydia trachomatis infections. Int J STD AIDS. 2025 May;36(6):434-449.
doi: 10.1177/09564624251323678.
Miller JM, Binnicker MJ, Campbell S, et al. A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology. Clin Infect Dis. 2018 Aug 31;67(6):e1-e94. doi: 10.1093/cid/ciy381.
Ludwig M. Diagnosis and therapy of acute prostatitis, epididymitis and orchitis. Andrologia 2008; 40:76–80.
Pepe P, Panella P, Pennisi M, et al. Does color Doppler sonography improve the clinic assessment of patients with acute scrotum? Eur J Radiol 2006; 60:120–4.
Trojian TH, Lishnak TS, Heiman D. Epididymitis and orchitis: an overview. Am Fam Physician 2009; 79:583–7.
Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. Published online July 23, 2021:1-187. doi:10.15585/mmwr.rr7004a1.
Farooq A, Armstrong WS. O'Leary MP, et al. (2025).Acute epididymitis in adolescents and adults. Up To Date. Retrieved January 2026 from https:// www. uptodate.com/ contents/acute-epididymitis-in-adolescents-andadults?Search=acute%20epididimytis&source=search_¬¬ result&selectedTitle=1~150&usage_type=default&display_rank=1.
Lynch S. Acute epididymitis. American Academy of Physician Assistants. 2018;31(3):50-51.
Azmat CE, Vaitla P. Orchitis. 2023 Jun 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. https://pubmed.ncbi.nlm.nih.gov/31985958/.
Wu H, Wang F, Tang D, et al. Mumps Orchitis: Clinical Aspects and Mechanisms.Front.Immunol.2021;12:582946. doi:10.3389/fimmu.2021.582946.
Ludwig M.Diagnosis and therapy of acute prostatitis, epididymitis andorchitis.Andrologia.2008;40(2):76-80.
doi:10.1111/j.14390272. 2007.00823.x.
Bonner M, Sheele JM, Cantillo-Campos S, et al. A Descriptive Analysis of Men Diagnosed With Epididymitis, Orchitis, or Both in the Emergency Department. Cureus. 2021; 13(6): e15800.
doi: 10.7759/cureus.15800.
