Epididymitis and orchitis Flashcards
Define epididymitis and orchitis
Inflammation of the epididymis or testes
60% of epididymitis is associated with orchitis
Most cases of orchitis are associated with epididymitis
Explain the aetiology/risk factors of epididymitis and orchitis
Most cases are INFECTIVE in origin
Bacterial
If < 35 yrs: Chlamydia and Gonococcus
If > 35 yrs: mainly coliforms (e.g. Enterobacter,Klebsiella)
RARE: TB, syphilis
Viral - Mumps
Fungal
Candida if immunocompromised
1/3 are IDIOPATHIC
Risk Factors
Diabetes
Rare: vasculitis (e.g. Henoch-Schonlein purpura)
Summarise the epidemiology of epididmytis and orchitis
COMMON
Affects all age groups
Most commonly: 20-30 yrs
Recognise the presenting symptoms of epididymitis and orchitis
Painful, swollen and tender testis or epididymis
NOTE: less acute onset than testicular torsion
Penile discharge
IMPORTANT: ask about sexual history
Recognise the signs of epididymitis and orchitis on physical examination
Swollen and tender epididymis or testis
Scrotum may be erythematous and oedematous
Pyrexia
Walking will be painful
Eliciting a cremasteric reflex may be painful
Identify appropriate investigations for epididymitis and orchitis
Urine
Dipstick
Early morning urine collections for MC&S
Bloods
FBC - high WCC
High CRP
U&Es
Imaging - Increased blood flow on duplex examination
Generate a management plan for epididymitis and orchitis
Medical - Antibiotics
Surgical - Exploration of testicles if testicular torsion
cannot be excluded clinically. Required if an abscess develops
Identify possible complications of epididymitis and orchitis
Pain
Abscess
Fournier’s gangrene (if the infection is left untreated and spreads)
Mumps orchitis could cause testicular atrophy and fertility issue
Summarise the prognosis for patients with epididymitis and orchitis
GOOD if treated
May take up to 2 months for the swelling to resolve
