Epididymitis and Orchitis

Question 1

Define epididymitis and epididymo-orchitis

Answer 1

inflammation of the epididymis characterised by scrotal pain and swelling of less than 6 weeks’ duration.
The condition is referred to as acute epididymo-orchitis if concurrent inflammation of the testis is present. (orchitis is the inflammation of the testicles)

Question 2

What is the most common cause of acute scrotal pain

Answer 2

epididymitis

Question 3

Epidemiology of epididymitis and orchitis

Answer 3

• 2.45 cases per 1000
• May occur any age, majority in the age 20-39
• 30% of post-pubertal males infected with mumps get orchitis

Question 4

Aetiology of epididymitis

Answer 4

Common causes:

Sexually active men - commonly STI pathogens e.g.:
N. gonorrhoeae
Chalmydia trachomatis

Older men and children- non STI pathogens
e.g. E.coli, TB

Question 5

Summarise the pathophysiology of epididymitis

Answer 5

retrograde ascent of urinary pathogens from the urethra and bladder, via the ejaculatory ducts and vas deferens, to the epididymis

Question 6

Risk factors

Answer 6

Unprotected sex (catch STI)
Gay men (anal sex = GIT has e coli)
Bladder outflow obstruction
Urinary tract instrumentation e.g. catheter

Question 7

Common causes of orchitis

Answer 7

Mumps
M tuberculosis
Syphilis
Autoimmune

Question 8

Presenting symptoms of epididymitis

Answer 8

-Unilateral scrotal pain with swelling of gradual onset (over few days)
-Symptoms of infection:
o Frequent and painful urination
o Purulent urethral discharge

Question 9

Presenting symptoms of orchitis

Answer 9

•	Testicular pain
•	Testicular swelling
•	Associated systemic symptoms
      o	Fatigue and malaise
      o	Fever and chills
      o	Nausea
•	Parotitis (begins 4-7 days before)

Question 10

Signs of epididymitis and orchitis

Answer 10

Epididymitis:
Testicular swelling, tenderness
Scrotal skin erythema and hot
Maybe fever
Orchitis:
Same as above + parotitis (sign of mumps)

Question 11

1st line investigations for epidydmitis and orchitis

Answer 11

Gram stain of urethral secretions (in men with discharge)
Urine dipstick test
Urine culture and microscopy

Question 12

Management

Answer 12

Bacterial: antibiotics (ceftriaxone, doxyclycine)

Question 13

complications of epididymitis and orchitis

Answer 13

Epi:
Abscess
infertility

orchitis:
testicular atrophy
hydrocele

Question 14

Prognosis

Answer 14

Epididymitis
-IF acute infectious, symptoms usually resolve rapidly with appropriate treatment
-However rapid improvement can lead to non-adherence and recurrence
Orchitis
-Most spontaneously resolve in 3-10 days
-Most bacterial cases resolve without complications with AB coverage