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Dr. Andrew Rynne

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Can epididymitis be treated with trimethoprim?

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Dr. Guru

General & Family Physician

Practicing since :2011

Answered : 589 Questions

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Posted on Wed, 27 Nov 2013 in Urinary and Bladder Problems
Question: can epididymitis be treated with trimethorpin?
doctor
Answered by Dr. Guru 45 minutes later
Brief Answer: Trimethoprim is not the drug of choice Detailed Answer: Hi, Thanks for consulting HealthcareMagic! Trimethoprim is not the drug of choice or firstline drug if the diagnosis of epididymitis is established. Empiric therapy is the one which is initiated before laboratory tests are available and is often started in case of epididymitis. Usually, ceftriaxone plus doxycycline are used for initial therapy of epididymitis. However, urinalysis and culture including initial stream, mid-stream, and after a prostate massage and tests for chlamydia and gonorrhea are required for definitive treatment. Hope I have answered your query. Let me know if you have have any clarifications. If not, you can close the discussion and rate the answer. If you like my answers and wish me to answer in future, bring it to my attention: Dr Vasanth. Url link is as follows: WWW.WWWW.WW Wish you good health!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Guru 7 minutes later
I have had epididymitis for 1 year. it does not clear up. I have had clear urine sample and no prostate massage. iam 42 married man. virgin before marriage. Please advise?
doctor
Answered by Dr. Guru 30 minutes later
Brief Answer: Please refer below Detailed Answer: Hi, Thanks for follow up! As I mentioned earlier, for identifying the specific organism, you may need to give "several specimens" of urine including initial stream, mid-stream, and after a prostate massage. Among sexually active men aged 40 years, E.coli is most common organism. The age groups mentioned are not very precise but approximate. Many patients who have epididymitis do get a recurrence at some stage for months or even years later. If recurrent symptoms are treated at an early stage with anti--inflammatory drugs, it may be possible to prevent further progression. It is, therefore, always worth keeping a supply of tablets to start as soon as symptoms appear, especially if you are away from home for any period of time. Early treatment will minimize the discomfort you experience and will shorten the duration of the symptoms. Chronic epididymitis may be associated with obstruction distal to the epididymis and also be seen in patients with congenital abnormalities of the lower urinary tract. So ruling out of these things is also advised with a Urology consult. If there is any suspicion that you have an underlying testicular tumour, an ultrasound scan of the scrotum may be recommended. Wish you good health!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Guru 29 minutes later
I have ultrasound of bladder, kidneys, testicles, dre exam, prostate ultrasound, Cystoscopy and no problem has been found. but my infection does not clear up ? I have seen a urologist. is there anything u think may be causing this?
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Answered by Dr. Guru 1 hour later
Brief Answer: I do not think that anything else is the cause Detailed Answer: Hi, I am sorry but in some cases of chronic epididymitis (like you), though it is clear that infection is the cause, doctors never find any signs of infection and the cause of the inflammation is unknown. I do not think that anything else apart from chronic epididymitis is causing this. Since the nature of chronic epididymitis itself is like this in many cases. I suggest to do follow ups with Urologist. Take care!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Guru 14 minutes later
can a flare up happen in chronic epididymitis turning it into acute epididymitis?
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Answered by Dr. Guru 2 hours later
Brief Answer: Yes, there is chance Detailed Answer: Hi, Yes, there is chance. And there is always fear of flare up that exists. Incompletely-treated acute epididymitis can, in time, become chronic if not treated adequately. Take Care!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Guru 3 minutes later
I currently got a flare up from chronic to acute. will the same antibiotic work again?
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Answered by Dr. Guru 58 minutes later
Brief Answer: No, it does not work out like that. Detailed Answer: No, it does not work out like that. We cannot be sure about which organism is causing it now. At this time it is prudent to discuss the change of medication with your treating doctor who had analyzed your problem better. Wish you good health!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Guru 5 minutes later
so would I now need a prostate massage to find out the germ which is causing this?
doctor
Answered by Dr. Guru 33 minutes later
Brief Answer: No, I don't think it's a compulsory requirement. Detailed Answer: No, I don't think it's a compulsory requirement. Based on physical examination findings, if your treating doctor suspects acute epididymitis, empiric therapy which usually consists of ceftriaxone plus doxycycline are used. However, as I mentioned earlier, based on the treatment response, urinalysis and culture including initial stream, mid-stream, and after a prostate massage and tests for chlamydia and gonorrhea are ordered for definitive treatment.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Guru 1 hour later
is there a possibility I have tb epididymitis or fungal epididymitis? if so how is this diagnosed?
doctor
Answered by Dr. Guru 9 hours later
Brief Answer: Yes, there is possibility, but rare Detailed Answer: Hi, Yes, there is rare possibility. But, as I mentioned earlier, the characteristic feature of "chronic" epididymitis, itself is persistent inflammation, even when there is no infection as opposed to acute epididymitis. There is also possibility of it being TB epididymitis or fungal epididymitis. TB epididymitis is generally looked for if there is known history of recent exposure to TB or in those, whose clinical status worsens despite appropriate antibiotic treatment. And on ultrasound, we can expect an enlarged hyperemic epididymis with multiple cysts and calcifications. So, if there is suspicion, your doctor would order gram stain etc. Epididymal aspiration/fine-needle aspiration cytology is one useful test if TB epididymitis is strongly suspected. Fungal epididymitis usually occurs in immunocompromised patients and is very rare. For both, TB epididymitis and Fungal epididymitis- all the all the investigations which we discussed above should suffice to give a hint(like urinalysis and culture including initial stream, mid-stream). I do not think there are special tests more than these. Wish you good health!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Guru 2 hours later
1 year ago I had ultra sound of testicles. do you think they would of picked up tb epididymitis in the ultrasound scan if it was present?
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Answered by Dr. Guru 1 hour later
Brief Answer: No, I don't think so. Detailed Answer: No, I don't think that they would of picked up TB epididymitis in the ultrasound scan done a year ago. The changes that I mentioned are gradual. However, suspecting TB in you is not reasonable as I do not think that you were at risk for TB. However, excluding it in those not responding properly to antibiotic and ant-inflammatory therapy is justifiable. Do not hesitate to ask any more clarifications you need. Take Care!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Guru 9 minutes later
hi so would it be reasonable to request a new ultrasound of testicles?
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Answered by Dr. Guru 17 minutes later
Brief Answer: It would be ok, but not strongly recommended Detailed Answer: It would be ok, but not very strongly recommended as I personally do not suspect TB based on the information given to me here. However, physical examination is mandatory to decide something like this. I wanted to say one more thing but did not wanted to discourage you. Chronic epididymitis is difficult to treat regardless of causative factors and unfortunately it cannot be cured completely in some cases. I repeat in "some cases" not all. Important thing to remember as I mentioned earlier is to treat recurrent symptoms with anti--inflammatory drugs at an early stage to prevent further progression. Hope this helps! Take care!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Guru 12 minutes later
hi dr. the problem iam having is symptoms improve with ofloxacin. when the course is completed the symptoms start to return after a few days. do you know what the cause of this could be?
doctor
Answered by Dr. Guru 11 minutes later
Brief Answer: Refer below Detailed Answer: Hi, I can understand the discomfort you are going through. Were you taking any other antinflammatory drugs apart from ofloxacin during the improvement of symptoms? You can also do one thing. If you are so sure that symptoms are improving with ofloxacin, we can suspect that some bacteria may be resistant to the antibiotics which you used. If this is the case, culture and sensitivity test of urine and urethral secretions could help in identifying the resistant and sensitive antibiotics. This would enable to choose the appropriate antibiotic. Discuss this with your treating doctor as well. Moreover, as you were asking that what the cause of this could be- The answer for this is - The nature of disease chronic epididymitis itself is like this. You can expect many recurrences without the evidence of infection but there would be inflammation. Take Care!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Guru 10 minutes later
hi, I have never taken anti inflammatory drugs only the antibiotics. also can this condition kill the patient through sepsis etc?
doctor
Answered by Dr. Guru 26 minutes later
Brief Answer: Refer below Detailed Answer: Can this condition kill the patient through sepsis- My answer is No. I have never seen any such patient. The reason why asked about- have used any anti inflammatory drugs in addition to ofloxacin is just that I wanted to know whether the improvement is because of those or ofloxacin. Anyhow it is better now to follow the things I have mentioned in previous answer- culture/sensitivity.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Guru 33 minutes later
what is the name of the anti inflammatory I can take ans would it affect my stomach? also is masturbation or sex allowed ib acute epididymitis?
doctor
Answered by Dr. Guru 1 hour later
Brief Answer: Refer below Detailed Answer: Hi, Yes, most of the anti inflammatory drugs would effect stomach. I am not allowed to prescribe you specific anti inflammatory drug. It would be unethical and inappropriate to prescribe you scheduled drugs without doing a proper examination. Usually, it is better to avoid masturbation or sex allowed in acute epididymitis. Take Care!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Guru 7 minutes later
you have been extremely beneficial. are you based in uk or india? also Sir one final question I feel if one day the pain is on the left side then right side is fine. if it goes to right side then left side is fine. Please could you kindly explain why this would be happening?
doctor
Answered by Dr. Guru 20 minutes later
Brief Answer: Thank You! Detailed Answer: Hi, Thank You. I have worked in USA as well but right now based in India. The reason for your second question may be- One thing is that the inflammation can be bilateral which is common in most of TB epidydimitis cases or it can be a referred pain in which the nerve supply of the two different regions where the pain is originating from will have same nerve supply. However, I do not think there can be a perfect explanation for this. Apologize for that. Or you may feel only pain of more intensity, though the pain is in both sides. Take Care and If you like my answers and wish me to answer in future, bring it to my attention: Dr Vasanth. Url link is as follows: WWW.WWWW.WW Meantime, you may want to close the discussion and rate the answer. Wish you good health!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Guru 43 minutes later
hi sir but the swelling on scan shows on left epididymis on the ultrasound scan. that is why im so confused. so what are your recommendations? have a prostate culture and tb test to rule this out ?
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Answered by Dr. Guru 3 hours later
Brief Answer: Refer below Detailed Answer: Do not think about your previous ultrasound. It does not give much information about your present condition. Get urinalysis and culture/sensivity mid stream initial stream, mid-stream urine. And get prescription for anti-inflammatory drugs based on physical exam and associated conditions. Other things can be decided based on the findings on these results. Follow up with Urologist. Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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