Epididymitis and orchitis Flashcards
Define them - UPDATE THIS PLS
Epididymitis - inflammation of the epididymis.
characterised by scrotal pain and swelling of less than 6 weeks’ duration. usually unilateral.
Orchitis - inflammation of the testes
The condition is referred to as acute epididymo-orchitis if concurrent inflammation of the testis is present.
What is the aetiology of epididymitis?
most commonly caused by bacterial infection
In men >35 years, majority = non STI
common uropathogens;
such as Escherichia coli and Enterococcus faecalis .
Among men <35 years, infection is commonly transmitted via sexual intercourse
organisms; Chlamydia trachomatis and Neisseria gonorrhoeae.
Others;
Viral ; Mumps
Fungal; Candida if immunocompromised
1/3 are IDIOPATHIC
Pathophysiology of epididymitis?
Retrograde ascent of urinary pathogens from the urethra and bladder, via the ejaculatory ducts and vas deferens, leads to colonisation and inflammation of the epididymis. The inflammatory process starts in the tail of the epididymis and subsequently spreads to the body and head of the epididymis
Risk factors?
Diabetes
Rare: vasculitis (e.g. Henoch-Schonlein purpura)
Epidemiology?
COMMON
Affects all age groups
Most commonly: 20-30 yrs
Name some risk factors?
unprotected sex
bladder outflow obstruction
cather or other urine tract instrumentation
Presenting symptoms?
Painful, erythematous, swollen hemiscrotum
Tender
swelling of gradual onset
enlargement of testis - orchitis included
NOTE: less acute onset than testicular torsion
Penile discharge; purulent suggest std
LUTS - if uti. so frequency, dysuria
possibly pyrexia - infectious cause
Signs?
Swollen and tender epididymis or testis
Scrotum may be erythematous and oedematous
Pyrexia
Walking will be painful
Eliciting a cremasteric reflex may be painful ; stroking superior and medial part of thigh
Investigations?
Urine;
(first void urine/ 1st one in morning)
Dipstick - positive leukocyte esterase/wbc = uti
MCS/Culture - causative organism
NAAT - nucleic acid amplification test (chlamydia trachomatis n gonorrhea)
Gram stain and culture of urethral secretions - usually gram negatives found (eg e.coli)
Others;
Imaging
1. enlarged hyperaemic epididymis on colour duplex ultrasonography
2. Surgical exploration where testicular torsion cannot be confidently excluded.
Generate a management plan for epididymitis and orchitis
Anitbiotics!
Sexually transmitted;
- Empirical ceftriaxone + doxycycline (if STI)
- Plus paracetamol or nsaid
- plus Levofloxacin if enteric infection
Not STI
- Empirical quinolone - levofloxacin
- Plus paracetamol or nsaid
Complications and prognosis?
Abscess
Fournier’s gangrene (if the infection is left untreated and spreads)
Mumps orchitis could cause testicular atrophy and fertility issues
prognosis
GOOD if treated
May take up to 2 months for the swelling to resolve
How does an epididymal cyst vary from epididymitis in presentation?
An epididymal cyst or spermatocele is a cyst of the head of the epididymis.
They are generally not painful.
