Epididymitis

Question 1

def

Answer 1

inflammation of the epididymis

Question 2

epi

Answer 2

common in black men

Question 3

aetiology

Answer 3

most commonly caused by bacterial infection
>35yrs:
1 E.coli
2. enterococcus faecalis
<35yrs:
commonly STIs
1 chlamydia trachomatis
2 neisseria gonorrhoeae

Question 4

risk factors

Answer 4

> 35yrs:
bladder outflow obstruction
<35yrs:
unprotected sexual intercourse (homosexual men)

Question 5

history

Answer 5

gradual onset one sided scrotal pain and swelling

Question 6

examination

Answer 6

unilateral redness, tenderness and swelling of the scrotum

fever may be associated

Question 7

what suggests a STI from the history

Answer 7

urethral discharge

Question 8

what suggests a lower urinary tract infection

Answer 8

frequent and painful urination

Question 9

investigations

Answer 9

1 gram stain and culture of urethral secretions
-identifies urethal inflammation
-identifies chlamydia trachomatis or neisseria gonorrhoeae
2 urine dipstick, microscopy and culture
-if dipstick is positive for leukocyte esterase it indicates urethritis or LUTI, microscopy confirms this
-MSU for culture is required to identify non-gonococcal, non-chlamydial urinary pathogens

Question 10

management for <35yrs (likely STIs)

Answer 10

ceftriaxone plus doxycycline

bedrest + scrotal elevation, analgesics, NSAIDs

Question 11

management for >35yrs (likely non STIs)

Answer 11

quinolones (such as ofloxacin)

bedrest + scrotal elevation, analgesics, NSAIDs

Question 12

complications

Answer 12

abscess formation
ischaemia or infarction of testis
infertility

Question 13

prognosis

Answer 13

most resolve rapidly with antibiotic treatment

Question 14

a 21y/o man presents with a 2/7 history of worsening left-sided scrotal pain and swelling. He reports white urethal discharge over the last 24hrs. Otherwise healthy. He is heterosexual and has a single female partner with whom he has unprotected sex. O/E a tender, erythematous, swollen left scrotum with a thickened epididmis is seen

Answer 14

epididymitis

Question 15

a 74y/o with a known history of prostatic enlargement and insuline requiring T2DM presents with a 7 day history of worsening right sided scrotal pain and swelling. Initial symptoms of dysuria and frequency have resolved since his GP prescribed antibiotics. O/E there is a tender, swollen right epididymis with associated hydrocele

Answer 15

epididymitis