However, radionuclide scanning of the scrotum is probably the most accurate way to confirm the diagnosis. Doppler ultrasound of the spermatic cord and testis may be useful if the operator is skilled and experienced. When the diagnosis is still not fairly clear, scrotal exploration should be done promptly. Treatment of acute epididymitis is dependent on the specific pathogen involved. General guidelines for sexually transmitted cases are followed and call for gram stain of urethral smear and culture.
Antibiotics commonly used include ceftriaxone, tetracycline, doxycycline, and quinolones.
General supportive measures include bed rest, ice pack, pain control, and scrotal elevation. This process refers to a very aggressive fulminating cellulitis and necrotizing fasciitis usually due to mixed infections including staph, strep, gram-negative and anaerobic organisms. Invasive infections of the lower genitourinary tract, colon, rectum, or genital skin are the most common prodromes. Most patients are adults. Alcoholism, diabetes mellitus, and immuno-suppression are the most likely underlying risk factor.