Epididymitis and Orchitis

Question 1

Define

Answer 1

• Acute epididymo-orchitis is a clinical syndrome consisting of pain, swelling and inflammation of the epididymis, with or without inflammation of the testes
• Orchitis alone (infection limited to testis) is less common

Question 2

Causes

Answer 2

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)

Question 3

Epidemiology

Answer 3

most commonly occurs in patients aged 15-30 years and patients older than 60 years

Question 4

Symptoms

Answer 4

• Sudden onset tender swelling
• Unilateral scrotal pain (may be bilateral)
• Dysuria
• Sweats/fever
• If due to STI ma see urethral discharge

Question 5

Signs

Answer 5

• Tenderness to palpation on affected side
• Palpable selling of epididymis
• ±Urethral discharge, 2ndary hydrocele, erythema or
• oedema of the scrotum
• Pyrexia

Question 6

Investigations

Answer 6

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 7

Management

Answer 7

Medical

• Antibiotics

Surgical

• Exploration of testicles if testicular torsion cannot be excluded clinically
• Required if an abscess develops

Question 8

Complications

Answer 8

Pain

Abscess

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

Mumps orchitis could cause testicular atrophy and fertility issues

Question 9

Prognosis

Answer 9

GOOD if treated

May take up to 2 months for the swelling to resolve