Epididymitis and Orchitis (Complete) Flashcards
Define epididymitis
Swelling and inflammation of the epididymis
Define orchitis
Inflammation of the testes
What is the relationship between orchitis and epididymitis?
Most cases of orchitis is associated with epididymitis
60% of cases of epididiymitis is associated with orchitis
Inflammation of both the epididymis and testses is known as?
Epididymo-orchitis
What is the most common cause of epididymitis and orchitis?
Infection
What is the most common infective cause of epididymitis and orchitis in <35 year olds?
Chlamydia trachomatis
What is the most common infective cause of epididymitis and orchitis in >35 year olds?
Mainly coliforms (rod-based bacteria) such as:
Klebsiella
E. coli
Enterococcus faecalis
List 3 examples of sexually transmitted bacterial causes of epididymitis and orchitis
Chlamydia trachomatis
Neisseria gonorrhea
Mycoplasma genitalium
List 7 examples of non-sexually transmitted causes of epididymitis and orchitis
Enteric pathogens such as:
E.coli
Klebsiella
Enterococcus faecalis
Tuberculosis
Brucella
Candida infection
Mumps (rare viral infective cause)
N.B. Enteric pathogens such as E.coli and klebsiella CAN be transmitted sexually if anal intercourse.
What are rarer non-infective causes of epididymitis and orchitis?
Trauma
Vasculitis (e.g. Bechet’s syndrome)
Drug-induced (e.g. amiodarone [anti-arrhythmic]).
What are the main risk factors for epididymitis and orchitis? (6)
Unprotected sexual intercourse
Anal intercourse
History of mumps (Viral cause)
Travel history (TB contacts)
Immunosupression (e.g. increased risk of candida)
Previous UTIs
Age > 19 years
What is the main presentation of epididymitis and orchitis?
Unilateral and gradual onset presentation of:
Swelling of scrotum
Erythematous and hot scrotum
Tenderness (may be reliveed by elevation of penis)
Less than 6 week presentation (acute)
Give 2 examples of rarer additonal presentations of epidiymitis and orchitis than can also help to predict the cause?
Painful or frequent micturation (Indicated UTI as the cause)
Purulent urethral discharge (Indicates STI cause)
What are the 1st order investigations and typical findings for patients with epididymitis?
Bedside:
Urine dipstick: Check for UTI causes
Urine microscopy and culture: Check for UTI causes
Urgent referal to sexual health clinic for STI testing: If STI causes suspected
Bloods
FBC: Elevated WCC
U&Es
Imaging:
Color duplex US: Rule out testicular torsion
When should imaging be considered in patients with epididymitis/orchitis?
Give 2 examples of these types of investigations
If testicular torsion cannot be ruled out.
Color duplex USS
Surgical exploration
What examination sign is indicative of epididymitis/orchitis?
Prehn’s sign: Lifting the scrotum alleviates pain
What differential must always be considered in patient’s suspected of epididymitis/orchitis and how can it be differentiated?
Testicular torsion
Pain is severe and sudden onset
No sign of an infective cause
Negative Prehn’s sign
What is the management plan for patients with epididymitis/orchitis?
Conservative measures:
Bed rest and scrotal elevation.
Medicine
Treat underlying cause: E.g. ABs, suspension of drugs.
Analgesia: Paracetomol and NSAIDs
Surgical/Invasive:
Abscess drainage if there if an abscess formation
What are some of the main complications that can arise in patients with epididymitis/orchitis due to the condition itself or management?
Abscess formation
Testicular ischamaeia/infarction
Chronic pain
Infertility (due to condition or surgery e.g. explorative)
Scarring/obstruction of the epidydimis (leading to infertility or sub-fertility)
What antibiotics are most commonly administered in epididymorchitis?
According to local guidelines, with the most common being:
Azithromycin
Ciprofloxacin
Doxycycline
