Epididymitis + Orchiditis

Question 1

What is Epididymitis + Orchiditis?

Answer 1

Inflammation of epididymis (epididymitis) or testes (orchitis)
60% of epididymitis is associated with orchitis
Most cases of orchitis are associated with epididymitis

Question 2

Describe the aetiology of Epididymitis + Orchiditis

Answer 2

Most cases are INFECTIVE in origin

1/3 are IDIOPATHIC

Question 3

What are the most common bacterial causes of Epididymitis + Orchiditis in under and over 35s? Name 2 rare causes

Answer 3

If < 35 yrs: Chlamydia, Gonococcus + Neisseria Gonorrhoea
If > 35 yrs: mainly coliforms (e.g. Enterobacter, Klebsiella)
RARE: TB, syphilis (ASK FOR RECENT TRAVEL)

Question 4

Other than bacterial list 3 other causes of Epididymitis + Orchiditis

Answer 4

Viral: Mumps
Fungal: Candida if immunocompromised
RARE: Reversible sterile epididymitis from amiodarone (antiarrhythmic drug)

Question 5

Describe the epidemiology of Epididymitis + Orchiditis

Answer 5

COMMON
Affects all age groups
Most commonly: 20-30 yrs

Question 6

List 4 risk factors for Epididymitis + Orchiditis

Answer 6

Unprotected sex
Bladder outflow obstruction
Rare: vasculitis (e.g. Behcets)
In children there is usually an underlying congenital abnormality

Question 7

List 4 symptoms of Epididymitis + Orchiditis

Answer 7

Painful, swollen, red + tender testis or epididymis
Penile discharge: found on primary catch urine sample
Dysuria
Sweats/fever

Question 8

List 5 signs of Epididymitis + Orchiditis

Answer 8

Swollen + tender epididymis or testis
Scrotum may be erythematous + oedematous
Pyrexia
Walking will be painful
Eliciting a cremasteric reflex may be painful

Question 9

What bloods are seen in Epididymitis + Orchiditis?

Answer 9

FBC: high WCC
High CRP
U+Es

Question 10

What investigations may be considered in Epididymitis + Orchiditis?

Answer 10

Imaging: Increased blood flow on duplex examination

Test for HIV + syphilis as at risk of STIs

Question 11

Describe the medical management of Epididymitis + Orchiditis

Answer 11

Abx
If Gonorrhoea/ chlamydia suspected: ceftriaxone (250mg IM single dose) + doxycycline (100mg orally BD for 2 weeks)
If gonorrhoea more likely: add azithromycine (1g orally single dose)
Enteric organisms suspected : ofloxacin (300mg) BD for 10 days
Analgesia
Scrotal support

Question 12

Describe the surgical management of Epididymitis + Orchiditis

Answer 12

Exploration of testicles if testicular torsion can’t be excluded clinically
Required if abscess develops for abscess drainage

Question 13

List complications of Epididymitis + Orchiditis

Answer 13

ALL VERY RARE
Pain
Abscess
Fournier’s gangrene (if infection left untreated + spreads)
Mumps orchitis could cause testicular atrophy + fertility issues

Question 14

What is the prognosis in Epididymitis + Orchiditis?

Answer 14

GOOD if treated

May take up to 2 months for swelling to resolve

Question 15

What should you ask about when taking history if you suspect Epididymitis + Orchiditis?

Answer 15

Sexual history

Question 16

Describe the onset of symptoms in Epididymitis + Orchiditis

Answer 16

Sudden onset but less acute onset than testicular torsion

Question 17

Name and describe a specific sign that may be seen in Epididymitis + Orchiditis

Answer 17

Phren’s sign: elevating testicle may relieve some pain