Epididymitis and Orchitis

Question 1

Define:

Answer 1

Inflammation of the testes (orchitis) or the epididymis

60% of Epididymitis associated with orchitis

Most of orchitis is associated with Epididymitis

Question 2

Aetiology:

Answer 2

Most have an infective cause
1/3 is idiopathic

Bacteria:
<35 years –> STI such as Chlamydia and Gonococcus
>35years –> more likely to be coliforms (enterobacter and klebsiella)
rare - TB and syphilis

Viral = mumps

Fungal - candida if immuocompromised

Question 3

Risk factors:

Answer 3

Diabetes

Rare - vasculitis

Question 4

Epidemiology:

Answer 4

Common

Can affect all ages but mostly 20-30 year olds

Question 5

Symptoms:

Answer 5

Painful, tender and swollen testis or epididymis
SUDDEN ONSET BUT LESS THAN TESTICULAR TORSION
Penile discharge
Dysuria
Sweats/fever

Question 6

Signs:

Answer 6

Swollen and tender epididymis or testis
Pain on walking
Eliciting the cremasteric reflex is painful (stroking inner thigh causes testes to contract and elevate)
Pyrexia
Scrotum may be erythematous and oedematous

Question 7

Investigations:

Answer 7

Urine = dipstick and MC&S (morning sample)

Bloods = FBC (increase WCC), increased CRP and U+Es

Imaging - increased bloodflow on duplex examination

Question 8

Management:

Answer 8

Antibiotics for 2-4weeks

<35yrs = doxycycline (chlamydia) if worried about Gonorrhea (ceftriaxone)

> 35yrs = more likely associated with UTI –> ciprofloxacin or ofloxacin

analgesia and scrotal support

Surgical –> exploration of testes if testicular torsion cannot be excluded or if an abscess develops.

Question 9

Complications:

Answer 9

Abscess
Pain
Fournier’s gangrene
Mumps orchitis = testicular atrophy and fertility issues

Question 10

Prognosis:

Answer 10

Good if treated

May take up to 2 months fro the swelling to resolve.