Epididymitis

Question 1

What is epididymitis?

Answer 1

Inflammation of the epididymis

Question 2

At what are is Epididymitis most likely to occur?

Answer 2

15-30 and over 60

Question 3

What is epidiymo-orchitis?

Answer 3

Inflammation of the epididymis and testes together, epididymitis commonly occurs on its own but orchitis does not usually

Question 4

What causes epididymo-orchitis?

Answer 4

usually local extension of infection from the lower urinary tract either via enteric (UTI) or non-enteric organisms (STI)

Question 5

At what ages is STI most likely to cause epididymo-orchitis?

Answer 5

under 35

Question 6

What STI will cause epididymo-orchitis?

Answer 6

Neisseria Gonorrhea and Chlamydia trachomatis

Question 7

If a male practices anal intercourse what other organs can cause epididymo-orchitis?

Answer 7

E coli

Question 8

If over 60 what are the most common enteric organisms that cause epididymo-orchitis?

Answer 8

E coli, Proteus spp, Klesiella pneumonie, and psydeonomas aeruginosa

Question 9

What is mumps orchitis?

Answer 9

unilateral or bilateral orchitis with fever about 4-8 days after mumps parotitis, will self resolve with supportive treatment

Question 10

What complications can arise due to mumps orchitis?

Answer 10

Testicular atrophy and infertility

Question 11

What are the risk factors for epididymo-orchitis?

Answer 11

MSM, Multiple partners, gonorrhoea, catheters, bladder outlet obstruction, immunocompromised states

Question 12

What are the clinical features of epididymo-orchitis?

Answer 12

Unilateral scrotal pain with swelling, fever and riggers, may also have LUTS, urethral discharge and dysuria, red, swollen and tender on palpation

Question 13

What is Prehns sign?

Answer 13

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

Question 14

What are the differential diagnosis for epididymo-orchitis?

Answer 14

testicular torsion (sudden and severe with no LUTS) testicular trauma, abscess, epididymal cyst, hydrocoele, testicular tumour

Question 15

What investigations would you preform for someone with suspected epididymo-orchitis?

Answer 15

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

Question 16

What imaging would you preform on someone with expected epididymo-orchitis?

Answer 16

Ultrasound imaging can be done of the testis with as US Doppler to confirm diagnosis and rule out others

Question 17

What is the initial management for someone with epididymo-orchitis?

Answer 17

Appropriate antibiotic therapy and analgesia, bed rest and scrotal support

Question 18

What antibiotics would be given to someone with an enteric organism epididymo-orchitis?

Answer 18

Ofloxacin 200mg PO BD for 14 days or Levofloxacin 500mg BD for 10 days

Question 19

What antibiotics would be given to someone with an STI organism epididymo-orchitis?

Answer 19

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)

Question 20

What are the complications of Epididymo-orchitis?

Answer 20

Reactive hydrocoele formation, abscess formation or testicular infarction