Epididymitis and orchitis

Question 1

What is epididymitis and orchitis

Answer 1

inflammation of epididymis or testis

most cases of orchitis are associated with epididymitis

Question 2

What causes most cases of epididymitis and orchitis

Answer 2

most cases are infective - bacterial

Question 3

What bacteria is usually responsible if one is less than 35 and sexually active

Answer 3

Chlamydia trachomatis or Neisseria gonorrhoeae
- spreads from genital tract

Question 4

Which bacteria is usually responsible if over 35 and low risk sexual history

Answer 4

E. coli
spreads from the bladder

Question 5

What are risk factors of epididymitis and orchitis

Answer 5

unprotected sex
bladder outflow obstruction
UTI
immunosuppression

trauma
vasculitis
Amiodarone

Question 6

How may someone present

Answer 6

develops over a few days
- unilateral testicular pain and swelling

• swollen, hot, tender erythematous scrotum

-pyrexia

-dysuria and urgency

-cremasteric reflex

-symptoms relative to the cause

Question 7

What is Prehn’s sign

Answer 7

alleviation of scrotal pain by lifting testicle and is suggestive of diagnosis of epididymitis

Question 8

What investigations are required

Answer 8

Assess for STI with nucleic acid amplification test

MSU ( midstream specimen of urine ) for microscopy and culture in older adults

Question 9

What other investigations should be considered

Answer 9

Colour duplex USS if unsure of diagnosis

surgical exploration if testicular torsion cannot be excluded

Question 10

What is the management

Answer 10

If STI is cause - refer to sexual health clinic

If organism unknown -
IM CEFTRIAXONE AND ORAL DOXYCYCLINE

If enteric organism
ORAL QUINOLONE – OFLOXACIN

bed rest and scrotal elevation

simple analgesia