Testicular torsion | Indications for surgery: | Suggestive history or physical examination | Similar episodes >2 weeks ago | No flow or spermatic cord knot by Doppler ultrasound | Diagnostic uncertainty¶ | Treatment: | Definitive: surgery | Temporizing: trial of manual detorsion | | Torsion of appendage | Admission criteria: | Testicular torsion excluded | Severe pain | Pain refractory to trial of analgesics and conservative management | Treatment: | Analgesics | Rest | | Acute epididymitis | Admission criteria: | Testicular torsion excluded | Severe pain | Immunocompromised | Not tolerating oral medications or noncompliant | Treatment: | Children: | If pyuria >3 WBC/hpf or positive culture, or if underlying GU abnormality: Antibiotic course against coliforms* | If no pyuria and negative culture: Antibiotics not required Extensive evaluation not required | Sexually active adolescents: | Heterosexual: empiric antibiotics (chlamydia, GC)Δ | Homosexual: empiric antibiotics (chlamydia, GC and coliforms)Δ | |