Epididymitis/Orchitis

Question 1

What is epididymo-orchitis?

Answer 1

Inflammation of epididymis and testicle. Can have one or other but commonly come together. Can occur because of STIs or UTIs

Question 2

What are the causes of epidiymitis/orchitis?

Answer 2

• STIs, eg, gonorrhoea or chlamydia (suspect in younger patients)
• UTIs - E.coli is most common cause
  Less common:
• Mumps (think mumps orchitis)
• Tuberculosis

Question 3

What are the signs and symptoms of epididymo-orchitis?

Answer 3

• Testicular swelling and tenderness
• Fever
• Dysuria
• Urethral discharge

Question 4

What are the differentials for epididymo-orchitis?

Answer 4

• Testicular torsion: most important one to rule out, differentiate using Prehn’s sign.
• Inguinal hernia
• Testicular caner

Question 5

What are the investigations for epidiymo-orchtis?

Answer 5

• Clinical history and exam (cremaster reflex and Prehns sign)
• Urinalysis and MSU
• STI screening
• Scrotal ultrasound if unsure about torsion

Question 6

What is the management of epididymo-orchitis?

Answer 6

• If STI is most likely and organism is unknown then ceftriaxone 500mg IM AND docy 100mg BD for 10-14 days.
• If UTI is suspected then treat with oral quinolone for 2 weeks eg, oflaxacin
• Scrotal elevation and rest

Question 7

What is Fournier’s Gangrene and it’s risk factors?

Answer 7

• Necrotising fasciitis which usually occurs > 50 years.
  Risk factors include UTIs, IBD, trauma or recent surgery

Question 8

What are the investigations and management of fournier’s gangrene?

Answer 8

Investiagations - Blood cultures, urine sample and tissue/pus sample.
Treatment - Surgical debridement and abx: Tazocin, gentamicin, metronidazole +/- clindamycin if toxins.