Acute Epididymo-orchitis Flashcards
Acute …-…. is a common cause of testicular pain and swelling.
Acute epididymo-orchitis is a common cause of testicular pain and swelling.
… … must be considered in anybody presenting with acute testicular pain, particularly in children, adolescents and younger men. If there is any diagnostic uncertainty, refer to urology / paediatric surgery.
Testicular torsion must be considered in anybody presenting with acute testicular pain, particularly in children, adolescents and younger men. If there is any diagnostic uncertainty, refer to urology / paediatric surgery.
Acute epididymo-orchitis is caused by what?
It is caused by acute inflammation of the epididymis (epididymitis) that may affect the testicle (orchitis). Most commonly the aetiology is infectious through the spread of pathogens from the urethra or bladder. It may be related to urinary tract infections or sexually transmitted infections.
Epididymo-orchitis is most commonly caused by … or ….
Epididymo-orchitis is most commonly caused by sexually transmitted infections or urinary pathogens.
What is considered in patients younger than 35 presenting with acute epididymo-orchitis?
Sexually transmitted organisms tend to be considered in patients younger than 35, who have had previous STIs or are engaging in high-risk sexual activities. Urinary tract infection-related organisms tend to be considered in patients older than 35, particularly in the presence of risk factors like recent catheterisation or recurrent UTIs.
Sexually transmitted infections (acute epididymis-orchitis) - 4
Neisseria gonorrhoeae
Chlamydia trachomatis
Mycoplasma genitalium
Gram-negative enteric organisms (in those engaging in penetrative anal sex)
Non-sexually transmitted infection (acute epididymo-orchitis) - 5
Gram-negative enteric organisms (e.g. Escherichia coli) Candida Mumps TB Brucellosis
Non-infections causes of acute epididymo-orchitis
Behcet’s disease
Amiodarone induced
In …-… boys, epididymitis is commonly non-infective and self-limiting.
In pre-pubertal boys, epididymitis is commonly non-infective and self-limiting.
Symptoms of acute epididymo-orchitis (4)
Testicular pain
Nausea and vomiting
Fever
Dysuria
Signs of acute epididymo-orchitis (6)
Testicular swelling Palpable, swollen, tender epididymis Testicular erythema Tender testicle Hydrocele (reactive) Urethral discharge
Bedside investigations for epididymo-orchitis (3)
Vital signs
Urine dipstick (send MSU)
Sexual health screen (or refer to local GUM clinic)
Bloods for investigating cause of epididymo-orchitis (7)
FBC UEs CRP Syphilis Bloodborne virus screen Mumps serology (if clinically indicated) Blood cultures (if pyrexial)
Imaging for acute epididymo-orchitis
USS may confirm the diagnosis, showing inflammation of the epididymis. Reactive hydroceles may be present.
USS is also useful to exclude testicular tumours, another cause of testicular pain.
Management of acute epididymo-orchitis
Antibiotics are used to treat suspected bacterial causes of epididymitis.
For the vast majority of patients, management is with antibiotics and symptomatic relief. Most can be managed on an outpatient basis but patients with signs of systemic or significant infection should be admitted for close monitoring and IV antibiotics.
Acute epididymo-orchitis management overview: (general guide)
General advice for acute epididymo-orchitis
Supportive care: simple analgesia with paracetamol and NSAIDs (if no contraindication) can be recommended. Scrotal support may offer some relief.
Sex: patients with suspected STI-related epididymo-orchitis should be advised to abstain from sex until the full results of their sexual health screen have returned.
Safety net: patients should be advised to return if symptoms do not settle within three days (some will fail initial antimicrobial therapy), the pain worsens or they become unwell.
Referral: an urgent outpatient USS and urology follow-up should be arranged to exclude a testicular tumour.
Antibiotics in STI related epididymo-orchitis:
Ceftriaxone, 500mg-1g, IM single dose AND
Doxycycline, 100mg BD, 10-14 days
Antibiotics in Urinary pathogen-related epididymo-orchitis:
Ofloxacin, 200mg BD, 14 days OR
Levofloxacin, 500mg, OD, 10 days
Complications of acute epididymo-orchitis:
Though rare, serious complications (testicular abscess, testicular infarction) may occur.
Testicular abscess
Testicular infarction
Subfertility
What are 3 possible complications of acute epididymo-orchitis?
Testicular abscess
Testicular infarction
Subfertility
