Epididymitis and Orchitis (Complete)

Question 1

Define epididymitis

Answer 1

Swelling and inflammation of the epididymis

Question 2

Define orchitis

Answer 2

Inflammation of the testes

Question 3

What is the relationship between orchitis and epididymitis?

Answer 3

Most cases of orchitis is associated with epididymitis

60% of cases of epididiymitis is associated with orchitis

Question 4

Inflammation of both the epididymis and testses is known as?

Answer 4

Epididymo-orchitis

Question 5

What is the most common cause of epididymitis and orchitis?

Answer 5

Infection

Question 6

What is the most common infective cause of epididymitis and orchitis in <35 year olds?

Answer 6

Chlamydia trachomatis

Question 7

What is the most common infective cause of epididymitis and orchitis in >35 year olds?

Answer 7

Mainly coliforms (rod-based bacteria) such as:

Klebsiella

E. coli

Enterococcus faecalis

Question 8

List 3 examples of sexually transmitted bacterial causes of epididymitis and orchitis

Answer 8

Chlamydia trachomatis

Neisseria gonorrhea

Mycoplasma genitalium

Question 9

List 7 examples of non-sexually transmitted causes of epididymitis and orchitis

Answer 9

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.

Question 10

What are rarer non-infective causes of epididymitis and orchitis?

Answer 10

Trauma

Vasculitis (e.g. Bechet’s syndrome)

Drug-induced (e.g. amiodarone [anti-arrhythmic]).

Question 11

What are the main risk factors for epididymitis and orchitis? (6)

Answer 11

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

Question 12

What is the main presentation of epididymitis and orchitis?

Answer 12

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)

Question 13

Give 2 examples of rarer additonal presentations of epidiymitis and orchitis than can also help to predict the cause?

Answer 13

Painful or frequent micturation (Indicated UTI as the cause)

Purulent urethral discharge (Indicates STI cause)

Question 14

What are the 1st order investigations and typical findings for patients with epididymitis?

Answer 14

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

Question 15

When should imaging be considered in patients with epididymitis/orchitis?

Give 2 examples of these types of investigations

Answer 15

If testicular torsion cannot be ruled out.

Color duplex USS

Surgical exploration

Question 16

What examination sign is indicative of epididymitis/orchitis?

Answer 16

Prehn’s sign: Lifting the scrotum alleviates pain

Question 17

What differential must always be considered in patient’s suspected of epididymitis/orchitis and how can it be differentiated?

Answer 17

Testicular torsion

Pain is severe and sudden onset

No sign of an infective cause

Negative Prehn’s sign

Question 18

What is the management plan for patients with epididymitis/orchitis?

Answer 18

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

Question 19

What are some of the main complications that can arise in patients with epididymitis/orchitis due to the condition itself or management?

Answer 19

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)

Question 20

What antibiotics are most commonly administered in epididymorchitis?

Answer 20

According to local guidelines, with the most common being:

Azithromycin

Ciprofloxacin

Doxycycline