Acute Epididimitis And Orchitis

Question 1

What is Orchitis

Answer 1

Inflammation of one or both testicles

Question 2

What is the most common causes of epididymitis and orchitis in young men vs older men

Answer 2

N. gonorrhoeae & C. trachomatis
• <35 years old
Escherichia coli & Pseudomonas spp.
• Older men

Question 3

S/S of epididymitis

Answer 3

Testicular pain, tenderness, and swelling
Tender epididymis

Question 4

S/S of Orchitis

Answer 4

Gradual onset scrotal pain & swelling, Unilateral
Generalized inflammation that spreads to adjacent testicle
Pain radiation to lower abdomen

Question 5

S/S of epididmyitis-orchitis

Answer 5

• Sitting is uncomfortable
• Scrotal wall erythema
• Reactive hydrocele
• Systemic signs: Urinary retention among elderly
• Prehn’s Sign: Partial or complete relief of pain, Suggest of epididymitis

Question 6

What is the empiric treatment plan for high risk STI epididymitis or orchitis

Answer 6

Cover N. gonorrhoeae and C. trachomatis
• Ceftriaxone 250 mg IM x1 plus Doxycycline 100 mg PO BID x10
days
Azithromycin 1 g orally x1 dose
Avoid fluoroquinolones: Gonorrhea widespread resistance

Question 7

What is the empiric treatment for low risk STI in Epididymitis and Orchitis

Answer 7

Low risk for STI
• Levofloxacin 500 PO QD x10 days
• Bactrim DS BID x10 days
• Insertive anal intercourse
• Cover for N. gonorrhoeae, C. trachomatis, and enteric pathogens
• Ceftriaxone 250 mg IM x1 dose plus Levofloxacin 500 mg PO
QD x10 days