epididymitis and orchitis

Question 1

definition of epididymits and orchitis

Answer 1

Inflammation of the epididymis or testes (orchitis).

60% of epididymitis are associated with orchitis and most cases of orchitis with epididymitis.

Question 2

aetiology of epididymitis and orchitis

Answer 2

majority infection - STI, UTI, post op

bacterial - <35yrs chlamydia or gonococcus, >35yrs coliforms, rare: TB, syphilis, e coli, mumps, N gonorrhoeae

viral - mumps

fungal - candida if immunocomprimised

1/3 idiopathic

may be associated with underlying testicular tumour

epididymis is elongated mass of convulated efferent tubes posterior and superior to the testes. Spermatazoa mature and gain their motility in this structure

Question 3

RF for epidiymitis and orchitis

Answer 3

dm

vasculitis eg Henoch-Schonlein purpura

urethral instrumentation and prostatic surgery

unprotected sex

Question 4

epidemiology of epididymitis and orchitis

Answer 4

common

affects all age

50% are 20-30yrs

Question 5

sx of epididymitis and orchitis

Answer 5

sudden onset

tender

painful

swollen

usually unilateral

less acute than torsion

penile discharge may occur in bacterial forms, fever

enquire about sexual history

dysuria

sweats

fever

Question 6

Ix for epididymitis and orchitis

Answer 6

urine

• dipstick
• early morning urine concentration - bacterial C&S and microscopy for acid-fast bacilli if TB suspected
• take first catch urine sample

blood

• FBC
• high WCC, CRP,
• UE

imaging

• increased blood flow on duplex exam
• US - local collection/abscess

after acute treatment - older pts investigated for bladder outlet obstruction eg flow studies or underlying malignancy

STI screen

Question 7

medical mx of epidymitis and orchitis

Answer 7

AB - IV if severe

Young patients where chlamydia is likely, doxycycline 100mg/2hr for 2 weeks and attendance as a genitourinary clinic for follow-up and contact tracing.

if gonorrhoea suspected add ceftriaxone 500mg IM stat

In older patients, quinolones (e.g. ciprofloxacin 500mg/12hr) are recommended for 2–4 week - associated UTI is common

analgesic and scrotal support

follow up - exclude malignancy

if TB - antituberculous regimen

Question 8

signs of epididymitis and orchitis

Answer 8

swollen and tender epididymis and/or testis

scrotum may be erythematous and oedematous

pyrexia

walking or even eliciting a cremaster reflex may be painful

Question 9

surgical mx for epididymitis and orchitis

Answer 9

exploration of scrotum if torsion cannot be excluded, or if abscess develops needing drainage

if TB epididymo-orchitis not responding to medical treatment

drainage of any abscess

Question 10

complications of epididymitis and orchitis

Answer 10

pain

abscess

if untreated - risk of spreading infection and Fournier’s gangrene

minimal risk to fertility if unilateral and treated

mumps orchitis may cause testicular atrophy and future fertility problems

Question 11

prognosis for epididymitis and orchitis

Answer 11

good if treated

may take up to 2mo for swelling to completely resolve