A 27-Year-Old Man Comes to the Emergency Department Due to Scrotal

question 70

Multiple Choice

A 27-year-old man comes to the emergency department due to scrotal pain.  Three days ago, he was diagnosed with acute epididymitis by his primary care physician and was treated with ceftriaxone and doxycycline.  Nuclear acid amplification test for Chlamydia trachomatis was positive.  He has persistent pain and states that he has been compliant with his oral doxycycline.  He denies anal intercourse.
Examination reveals tenderness and swelling involving the left side of the scrotal sac.  The pain is relieved with elevation of the sac and the cremasteric reflex is equivocal.  Rectal examination shows a normal-sized and nontender prostate.
Which of the following is the most appropriate next step in management?

• A)Add levofloxacin
• B)Change doxycycline to azithromycin
• C)Discuss HIV and syphilis testing
• D)Reassure and provide analgesics
• E)Scrotal ultrasound

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