Epididymitis and orchitis

Question 1

What are causes of epididymitis and orchitis?

Answer 1

Local extension of an infection from the lower urinary tract.

Either enteric or non-enteric organism.

Question 2

What are risk factors for epididymitis and orchitis?

Answer 2

• MSM
• Multiple sexual partners
• Sex with someone with STI
○ Non-enteric

• Recent catheterisation
• BOO 
• Immunocompromised Enteric

Question 3

What are causes of epididymitis and orchitis?

Answer 3

Enteric: E coli, klebisella, pseudomonas

Non-enteric: chlamydia and gonorrhoea

Mumps can cause orchitis

Question 4

What are Sx of epididymitis and orchitis?

Answer 4

Unilateral scrotal pain tender on palpation

Swelling

Storage LUTS and dysuria

May be discharge

Fever + rigors

Cremasteric reflex and Prehn’s test are positive (pain relieved by elevated scrotum)

Question 5

What DDx for epididymitis and orchitis?

Answer 5

• Testicular torsion
  
  • Testicular trauma
  • Testicular abscess
  • Epididymal cyst
  • Hydrocoele
  • Tumour

Question 6

What Ix in epididymitis and orchitis?

Answer 6

Urine dipstick: infection? Culture + NAAT

Bloods: FBC, CRP, cultures

Imaging: US doppler of testes can be done

Question 7

What is Rx of epididymitis and orchitis?

Answer 7

Antibiotics: for enteric, give ofloxacin/levofloxacin PO. For non-enteric, give ceftriaxone and doxycycline.

Analgesia

Question 8

What are complications of epididymitis and orchitis?

Answer 8

• Reactive hydrocoele formation
• Abscess
• Testicular infarction
Infertility