Epididymitis and Orchitis

Question 1

Define epididymitis and orchitis

Answer 1

inflammation of the epididymis or testes

60% of epididymitis is associated with orchitis

Most cases of orchitis are associated with epididymitis

Question 2

orchitis

Answer 2

inflammation of one or both testicles. bacterial/ viral/ unknown causes.
sti

Question 3

epididymis

Answer 3

the tube (epididymis) back of testicles become swollen and painful.
infection
treated with antibiotics

Question 4

Explain the aetiology

Answer 4

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

Question 5

Risk Factors

Answer 5

Diabetes

Rare: vasculitis (e.g. Henoch-Schonlein purpura)

Question 6

Summarise the epidemiology of epididmytis and orchitis

Answer 6

COMMON

Affects all age groups

Most commonly: 20-30 yrs

Question 7

Recognise the presenting symptoms of epididymitis and orchitis

Answer 7

Painful, swollen and tender testis or epididymis

NOTE: less acute onset than testicular torsion

Penile discharge

IMPORTANT: ask about sexual history

Question 8

Recognise the signs of epididymitis and orchitis on physical examination

Answer 8

Swollen and tender epididymis or testis

Scrotum may be erythematous and oedematous

Pyrexia

Walking will be painful

Eliciting a cremasteric reflex may be painful

Question 9

Identify appropriate investigations for epididymitis and orchitis

Answer 9

Urine

Dipstick

Early morning urine collections for MC&S

Bloods

FBC - high WCC

High CRP

U&Es

Imaging

Increased blood flow on duplex examination

Question 10

Generate a management plan for epididymitis and orchitis

Answer 10

Medical

Antibiotics

Surgical

Exploration of testicles if testicular torsion cannot be excluded clinically

Required if an abscess develops

Question 11

Identify possible complications of epididymitis and orchitis

Answer 11

Pain

Abscess

Fournier’s gangrene (if the infection is left untreated and spreads)

Mumps orchitis could cause testicular atrophy and fertility issues

Question 12

Summarise the prognosis for patients with epididymitis and orchitis

Answer 12

GOOD if treated

May take up to 2 months for the swelling to resolve