Epididymitis and Orchitis

Question 1

Define epididymitis and orchitis

Answer 1

Inflammation of the epididymis and testes

Question 2

What are the causes/risk factors of epididymitis and orchitis?

Answer 2

• GI infection e.g. E. coli, Enterococcus
• STI e.g. Chlamydia, N. gonorrhoeae
• Viral e.g. mumps – associated with parotid swelling

Risk Factors
• Unprotected sexual intercourse
• Bladder outflow obstruction
• Urinary tract instrumentation

Question 3

What are the symptoms of epididymitis and orchitis?

Answer 3

• Unilateral scrotal/testicular pain
• Swelling
• Frequency
• Dysuria
• Urethral discharge

Question 4

What are the signs of epididymitis and orchitis?

Answer 4

• Scrotal /testicular tenderness
• Hot, erythematous, swollen hemiscrotum
• Pyrexia

Question 5

What invetsigations are carried out for epididymitis and orchitis?

Answer 5

• Urine Dipstick - positive leukocyte esterase test shown as colour change on the reagent strip.
• Urine Microscopy - Leucocytes: ≥10 WBC per high-power field
• Urine Culture - a mid-stream urine specimen is required.
- Culture identifies non-gonococcal, non-chlamydial urinary pathogens.
- Identifies the causative organism in infective epididymo-orchitis.
• Urethral Swab - culture of urethral secretions.
- Positive culture of N. Gonorrhoea or C. Trachomatis
• FBC - leukocytosis
• U&Es - normal; for baseline monitoring.
• CRP - elevated
• USS - may reveal local collection or abscess.
• Duplex USS - increased blood flow to testes.

Question 6

What is the management of epididymitis and orchitis

Answer 6

Medical:
• Antibiotic treatment, if severe may need IV treatment initially.
• Young patients where chlamydia is likely, doxycycline and ceftriaxone for 2 weeks and attendance as a genitourinary clinic for follow-up and contact tracing.
• In older patients, quinolones (e.g. ciprofloxacin) are recommended for 2–4 weeks.
• If TB is suspected, anti-tuberculous regimen is necessary.
• Adequate analgesic and scrotal support.
• Follow-up is still recommended to exclude testicular malignancy.

Surgical:
• Exploration of scrotum if testicular torsion cannot be excluded or if an abscess develops that requires drainage.
• Also performed in cases of tuberculous epididymo-orchitis not responding to medical treatment.

Question 7

What are the complications of epididymitis and orchitis?

Answer 7

• Pain
• Abscess –If untreated, risk of spreading infection and Fournier’s gangrene (a type of necrotizing fasciitis or gangrene affecting the external genitalia and/or perineum).
• Minimal risk to fertility if unilateral and treated.
• Mumps orchitis may cause testicular atrophy and future fertility problems