Epididymitis and orchitis Flashcards

1
Q

Define epididymitis

A

inflammation of the epididymis characterised by scrotal pain and swelling (orchitis) of less than 6 weeks duration

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2
Q

Define epididymo-orchitis

A

Syndrome consisting of pain, swelling, and inflammation of the epididymis and/or testis

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3
Q

What is the aetiology of epididymitis and orchitis in pre-pubertal children

A

Idiopathic, self-limiting
Viral infection: adenovirus, enterovirus etc.
Reflux of urine into the ejaculatory ducts - structural urogenital abnormalities

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4
Q

What are the causes of epididymitis and orchitis in post-pubertal adolescents

A

Infection:
- STIs: CHLAMYDIA, gonorrhoea, mycoplasma genitalium, E. coli
- GI: E. coli, enterococcus faecalis
- TB
- Candida (Immunocompromised)
- MUMPS (viral)

Non-infection
Amiodarone use
Behçet’s syndrome and Henoch-Schönlein purpura

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5
Q

What are the risk factors for Epididymitis & Orchitis

A

Unprotected sexual intercourse
Bladder outflow obstruction - BPH, urethral stricture, bladder neck obstruction
Instrumentation of urinary tract - cytoscopic procedures and catheterisation
Immunosuppression
Vasculitis
Amiodarone
Mumps
Exposure to TB

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6
Q

What are the symptoms and signs of epididymitis and orchitis

A

Unilateral scrotal pain and swelling
- Gradual onset, course of a few days
- <6 weeks duration
Tenderness
Hot, erythematous, swollen hemiscrotum
Diffuse enlargement of the testis in epididymo-orchitis
Frequent and painful micturition
Purulent urethral discharge
Pyrexia

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7
Q

What investigations should be done for epididymitis and orchitis

A

Bedside:
- Urine dipstick: +ve leukocyte esterase
- MSU for MC&S: ≥10 WBC per high-power field, culture of causative organism
- Urethral secretion for NAAT
Bloods: HIV serology
Other: surgical exploration (torsion suspected), colour duplex US (enlarged, hyperaemic)

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8
Q

What is the management for epididymitis and orchitis in prepubertal children

A

UTI confirmed: Abx according to UTI treatment regimens

UTI not confirmed: treatment not required
- Reassure that epididymitis is usually a self-limiting conditions
- Ensure bed rest
- Can use paracetamol or ibuprofen for analgesia

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9
Q

What is the management for epididymitis and orchitis in adolescents

A

Manage based on causative organism
STI: refer to GUM clinic, Abx
- Unknown organism: likely chlam/gon → ceftriaxone AND docycline
Enteric: oral ofloxacin for 14 days
Viral: supportive only
amiodarone: dose reduction or discontinue
Vasculitis: refer to rheumatologist

Self-management measures
- Rest
- Scrotal support (supportive underwear)
- Paracetamol and/or ibuprofen for analgesia
- Return if no improvement in 3 days
Resource: British Association for Sexual Health and HIV (BASHH) leaflet

+ follow up after 2 weeks (Reassure that scrotal swelling completely resolves in more than 80% of people by 3 months after antibiotic treatment)

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10
Q

What are the complications of epididymitis and orchitis

A

Sepsis
Abscess formations
Testicular ischaemia/infarction
Epididymal obstruction
Chronic pain following epididymitis
Male factor infertility from testicular atrophy (mumps orchitis)
Reactive hydrocoele

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11
Q

What is the prognosis for epididymitis and orchitis

A

In men with infectious acute epididymitis, symptoms usually resolve rapidly following antibiotic therapy initiation
Could lead to treatment non-adherence and recurrence
Inadequately treated epididymitis, particularly STIs, can lead to epididymal obstruction or testicular atrophy -> infertility problems

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