Epididymitis

Question 1

What is epididymo-orchitis?

Answer 1

• clinical syndrome consisting of pain, swelling and inflammation of the epididymis, with or without inflammation of the testes

Question 2

What are the causes of epididymitis?

Answer 2

• local extension of infection from the lower urinary tract (bladder and urethra)
• <35 - commonly due to STI
• >35 - commonly due to UTI
• Mumps
• Ureaplasma urealyticum
• Behçet’s disease
• Amiodarone (>200mg/day)

Question 3

What age group is affected in epididymitis?

*bimodial

Answer 3

• 15-30 & >60
• <35 - commonly due to STI
• >35 - commonly due to UTI

Question 4

What are the RF for EO?

* think for STI and UTI

Answer 4

RF for STI

• MSM
• Multiple sexual partners
• Contact c Gonorrhoea

RF for UTI

• catheterisation
• bladder outlet obstruction
• immunocompromised

Question 6

What are the clinical features of EO?

Answer 6

• unilateral scrotal pain and swelling
• Fever
• dysuria
• LUTS
• discharge
• red and swollen testicle - tender on palpation
• +/- hydrocoele
• intact cremasteric reflex
• • Phren’s sign
• Mumps/TB sign

Question 7

What is Phren’s sign?

Answer 7

• Pt in supine position
• Scrotum is elevated
• If pain relieved by elevation > + Phren’s sign > epididymitis

Question 8

What are the differential diagnosis for EO?

Answer 8

• Testicular torsion (surgical emergency)
  
  • Pain more sudden onset, severe, absence of LUTS
• Testicular trauma
• Testicular abcess
• Epididymal cyst
• Hydrocoele
• Testicular tumour

Question 9

What Ix would you order for EO?

Answer 9

Bedside

• Urine dipstick
• Urethral swab for NAAT for N.Gonnorhoea, C Trachomatis
• MSU for M&C

Bloods

• FBC
• CRP
• Blood culture

Imaging

• Colour doppler USS

Question 10

How would you mx EO?

Answer 10

• If enteric organism
  
  • Ofloxacin 200mg PO BD for 14 days or levofloxacin 500mg BD for 10 days
• If STI organism
  
  • 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)
• Abstain from sexual activity until abx course complete

Question 11

What are the cx of EO?

Answer 11

• Reactive hydrocoele
• Abcess formation (rare)
• testicular infarction (rare)