Epididymitis Flashcards
What is epididymitis?
Inflammation of epididymis
What age is epididymitis most common?
Bimodal age distribution - 15-30 years and >60 years
What commonly occurs with epididmyitis?
Orchitis
Is epididymitis or epididymo-orchitis more commoN?
Epididymitis (most cases are soley this)
Is sole orchitis common?
No, very rare (mostly viral origin)
What is epididymo-orchitis usually caused by?
Local extension of infection from the lower urinary tract (bladder and urethra)
What can cause infection of the lower urinary tract leading to epididymo-orchitis?
- Enteric, i.e. classic UTI
- Non-enteric, i.e. sexually transmitted
What is the most likely mechanism of epididymo-orchitis in men <35 years old?
STI
What are the most common organisations causing STI epididymo-orchitis?
- N. gonorrhoeae
- C. trachomatis
What is a common cause of STI epididymo-orchitis in men who have anal intercourse?
Enteric organisms such as E. Coli
What is the most likely mechanism of epidiymo-orchitis in men >35 years old
Enteric organisms
What are the most common organisms causing enteric epididymo-orchitis?
- E. Coli
- Proteus
- Klebsiella
- Pseudomonas
What might mumps occur as a common complication of?
Mumps viral infectio n
What % of post-pubertal with mumps infection get orchitis?
40%
How does mumps orchitis present?
As unilateral or bilateral orchitis, typically with fever around 4-8 days after onset of mumps parotiditis
How long does mumps orchitis last?
Self-resolves within a week
Is any management required for mumps orchitis?
Supportive management only
How complications can mumps orchitis cause?
- Testicular atrophy
- Infertility
What investigation should be done if mumps is suspected?
IgM/IgG serology
What clerical thing needs to be done in cases of mumps?
Notifiable disease - local Health Protection Team must be informed
What do the risk factors for epididymo-orchitis depend on?
The underlying cause - STI or UTI
What are the risk factors for non-enteric epididymo-orchitis?
- MSM
- Multiple sexual partners
- Known contract of gonorrhoea
What are the risk factors for enteric epididymo-orchitis?
- Recent instrumentation or catheterisation
- Bladder outlet obstruction
- Immunocompromised
How does epididymitis usually present?
Unilateral scrotal pain and swelling.
Fever and rigors can also be present
What other symptoms may be present with epididymo-orchitis?
Symptoms secondary to underlying cause, e.g. dysuria, storage LUTS, urethral discharge
What may be found on examination in epididymo-orchitis?
Epididymis +/- testis will be very tender on palpation, and may be associated hydrocele
What specific tests can be used in epididymitis?
- Cremasteric reflex
- Prehn’s sign
What happens to the cremastic reflex in epidiymitis?
Nothing - it is in tact
What does a positive Prehn’s sign in epididymitis?
Suggestive of epididymitis
How is Prehn’s sign elicited?
The patient is supine and scrotum is elevated by examiner - positive is when pain is relieved by elevation
What is the main differential of epididymitis?
Testicular torsion
How does the presentation of testicular torsion differ from epididymitis?
In torsion, pain is more sudden onset and severe, and absence of LUTS
What can aid in the diagnosis of testicular torsion?
Dopper US (but if any significant suspicion of torsion, urgent scrotal exploration)
What are the other differentials for epididymitis?
- Testicular trauma
- Testicular abscess
- Epididymal cyst
- Hydrocoele
- Testicular tumour
What investigations may be done in suspected epididymitis?
- Urine dipstick
- First void urine sent for NAAT
- Routine bloods
When should first-void urine be done in suspected epididymitis?
Suspected non-enteric epididymitis
What may be warranted depending on history in suspected non-enteric epididymitis?
Further STI screening
What routine bloods should be done in epididymitis?
- FBC
- CRP
Describe the role of ultrasound imaging in suspected epididymitis?
Diagnosis is usually clinical oen, but ultrasound imaging of testes via US doppler may be useful to confirm diagnosis and rule out any complications, e.g. testicualr abscess
On what basis can the majority of patients with epididymitis be managed?
Outpatient
When may patients with epididymitis need to be managed as inpatient?
- Evidence of systemic infection
- Uncontrolled pain
- Needs further investigation
What should be involved in the initial management of epididymitis?
- Appropriate antibiotic therapy
- Sufficient analgesia
- Bed rest
- Scrotal support
- Abstain from sexual activity
What is the first line antibiotic for enteric epididymitis?
Ofloxacin PO BD for 14 days
What is the first line antibiotic for STI epididymitis?
Ceftriaxone 500mg IM single dose
How long should patients with epididymitis abstain from sexual activity?
Until antibiotic course is completed and symptoms resolve
What counselling should patients with STI epididymitis get?
Appropriate barrier contraception to reduce the risk of sexually transmitted infections
What follow up is required with epididymitis?
Routine follow up not typically recommended, but patient should seek further assessment if symptoms do not resolve or deteriorate
What may be required for management of chronic epididymitis?
Orchiectomy
How quickly do symptoms typically resolve in epididymitis?
Within 48 hours of starting abx
What complications may arise from epididymitis?
- Reactive hydrocele formation
- Abscess formation
- Testicular infarction
