Epididymitis Flashcards
What is epididymitis?
Inflammation of the epididymis
At what are is Epididymitis most likely to occur?
15-30 and over 60
What is epidiymo-orchitis?
Inflammation of the epididymis and testes together, epididymitis commonly occurs on its own but orchitis does not usually
What causes epididymo-orchitis?
usually local extension of infection from the lower urinary tract either via enteric (UTI) or non-enteric organisms (STI)
At what ages is STI most likely to cause epididymo-orchitis?
under 35
What STI will cause epididymo-orchitis?
Neisseria Gonorrhea and Chlamydia trachomatis
If a male practices anal intercourse what other organs can cause epididymo-orchitis?
E coli
If over 60 what are the most common enteric organisms that cause epididymo-orchitis?
E coli, Proteus spp, Klesiella pneumonie, and psydeonomas aeruginosa
What is mumps orchitis?
unilateral or bilateral orchitis with fever about 4-8 days after mumps parotitis, will self resolve with supportive treatment
What complications can arise due to mumps orchitis?
Testicular atrophy and infertility
What are the risk factors for epididymo-orchitis?
MSM, Multiple partners, gonorrhoea, catheters, bladder outlet obstruction, immunocompromised states
What are the clinical features of epididymo-orchitis?
Unilateral scrotal pain with swelling, fever and riggers, may also have LUTS, urethral discharge and dysuria, red, swollen and tender on palpation
What is Prehns sign?
patient is supine and the scrotum is elevated by the examiner, if pain is relieved by elevation, the test is positive and it is likely epididymitis, however has poor specificity
What are the differential diagnosis for epididymo-orchitis?
testicular torsion (sudden and severe with no LUTS) testicular trauma, abscess, epididymal cyst, hydrocoele, testicular tumour
What investigations would you preform for someone with suspected epididymo-orchitis?
Urine dipstick, urine culture, first void urine and sent for a NAAT to assess for gonorrhoea, chlamydia and M genitalium, as well as other STI screening, routine bloods, and if infection present then blood cultures
What imaging would you preform on someone with expected epididymo-orchitis?
Ultrasound imaging can be done of the testis with as US Doppler to confirm diagnosis and rule out others
What is the initial management for someone with epididymo-orchitis?
Appropriate antibiotic therapy and analgesia, bed rest and scrotal support
What antibiotics would be given to someone with an enteric organism epididymo-orchitis?
Ofloxacin 200mg PO BD for 14 days or Levofloxacin 500mg BD for 10 days
What antibiotics would be given to someone with an STI organism epididymo-orchitis?
Ceftriaxone 500mg IM single dose and Doxycycline 100mg PO twice daily for 10-14 days (with Azithromycin 1g PO single dose added if gonorrhoea likely)
What are the complications of Epididymo-orchitis?
Reactive hydrocoele formation, abscess formation or testicular infarction
