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    CDC releases the 1998 guidelines for the is bactrim good for cellulitis of sexually transmitted diseases. Am Fam Physician.history of Sexually Transmitted Infection trenuous ExerciseBicycle or motorcycle ridingProlonged sittingTrauma Additional risks in prepubescent males and those over age 35 yearsUrinary tract proceduresProstatic obstruction older men or other Bladder outlet obstructionMeatal stenosisPosterior Urethral valves boys Critical to differentiate uncommon outside ages 8 to 35 years and newborns Gradual onset of unilateral Scrotal PainPain localizes to posterior TesticlePain may radiate to opposite Testicle or into lower AbdomenContrast with Testicular Torsion where pain is sudden and unilateralTesticular Torsion pain may recur if torsion is intermittent rare in Epididymitis rchitis may also present with sudden unilateral Testicular Pain and often comorbid with Bactrim abscess of Urinary Tract Infection rare in Testicular Torsion everUrethral dischargeUrinary FrequencyUrinary urgencyDysuriaHematuria Epididymis inflammationTenderness to palpation at the epididymis, superior and posterolateral to TesticleEpididymis is enlarged and indurated Adjacent scrotal and testicular inflammation may occur with Testicular Torsion or infectionOrchitis and Testicular Torsion both cause Testicular Swelling, scrotal erythema, reactive Hydrocele Cremasteric Reflex present in both Orchitis and EpididymitisStroking inner thigh, retracts TesticleAbsent in Testicular Torsion Prehn's Sign PositiveElevation of Scrotum relieves is bactrim good for cellulitis of EpididymitisIn contrast, with Testicular Torsion, does not offer relief, and may exacerbate painUnreliable as a single test in distinguishing Epididymitis from Testicular Torsion Testes assume normal position in Epididymitis and Orchitis ontrast with Testicular Torsion where the Testicle is high-riding with transverse orientation Urinalysis and Urine Culture first void urine samples are preferred ften normal despite EpididymitisPyuria Urethritis may be present in Epididymitis and absent in Testicular TorsionLeukocyte esterase positiveUrine White Blood Cells present on microscopy C-Reactive Protein CRP ncreased in Epididymitis and Orchitis 24 mg/L in most casesC-RP is typically is bactrim good for cellulitis in Testicular TorsionC-RP processing time may preclude use to triage UltrasoundTest Sensitivity 96% Test Specificity 92% Doehn 2001 Eur Urol 39: 15-21PubMed Sexually Transmitted Disease testing PCR Urethral swab or first-void urine eisseriaGonorrhea PCRChlamydia trachomatis PCR IndicationsConsider in all cases where Testicular Torsion cannot otherwise be excludedDifferentiates Epididymitis and Orchitis increased blood flow from Testicular Torsion absent blood flow Torsion of appendix TestisAppendage spherical and 5mmIncreased periappendiceal blood flow BackgroundCiprofloxacin alone is not considered adequate coverage for Epididymitis Chlamydia resistance hildren 2-14 yo should typically only be treated with antibiotics if positive Urinalysis or Urine Culture Gonorrhea and Chlamydia Treatment empirically is bactrim good for cellulitis those between ages 14 and 35 years eftriaxone Rocephin 250 mg IM for 1 is bactrim good for cellulitis ANDDoxycycline 100 mg twice daily for 10 daysZithromax 1g PO for 1 dose has been used as an alternative but is not a CDC recommendation Urinary tract source treatment those not sexually active, or outside the 14-35 age range irst-line agentsOfloxacin 300 mg orally twice daily for 10 daysLevofloxacin 500 mg orally once daily for 10 daysAlternative agentsAmoxicillin-Clavulanate Augmentin.

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