Acute Epididymo-Orchitis

Question 1

What is Epididymo-Orchitis?

Answer 1

Inflammation of the epididymis and testis.

Question 2

Anatomy of Testis (2).

Answer 2

1. Epididymis is posterior to testis.

2. Sperm –> Testis –> Head of Epididymis (Top of Testis) –> Body –> Tail.

Question 3

Function of Epididymis (3).

Answer 3

1. Store sperm.
2. Site of spermatic maturation.
3. Drain into vas deferens.

Question 4

Differential Diagnosis of Epididymo-Orchitis.

Answer 4

TESTICULAR TORSION - treat as this until identified : tenderness is usually confined to the epididymis in epididymis-orchitis but torsion affects the entire testis.

Question 5

Commonest causative organisms of Epididymo-Orchitis (4).

Answer 5

1. E. coli.
2. C. trachomatis.
3. N. gonorrhoea.
4. Mumps - parotitis and orchitis.

Question 6

Aetiology of Epididymo-Orchitis.

Answer 6

Local spread of infections from the genital tract e.g. Gonorrhoea, Chlamydia or bladder. Iatrogenic : Amiodarone.

Question 7

Investigations of Epididymo-Orchitis.

Answer 7

1. Diagnosis - US Scrotal.

2. Distinguish Enteric or STI (Age < 35; Increased Number of Sexual Partners; Urethral Discharge).

Question 8

Management of Epididymo-Orchitis.

Answer 8

1. High-Risk of STI : GUM Referral.
2. Low-Risk : Ofloxacin for 14 days (or Levofloxacin, Ciprofloxacin, Doxycycline, Co-Amoxiclav).
3. Abstinence, Analgesia, Low Physical Activity, Supportive Underwear.
4. Unknown Organism : Ceftriaxone 500mg IM Single Dose with Doxycycline 100mg Orally twice daily for 10-14 days.

Question 9

Why are Floxacins used?

Answer 9

Broad-Spectrum antibiotics - gram-negative cover.

Question 10

Adverse Effects of Floxacins.

Answer 10

1. Tendon Damage/Rupture e.g. Achilles.

2. Lowering of Seizure Threshold.