Epididymitis/orchitis

Question 1

Anatomy of the epididymis

Answer 1

Question 2

What is epididymitis?

Answer 2

• Inflammation of the epididymis
• Peaks at 15-30 and >60 yrs old

Question 3

What is orchitis?

Answer 3

Inflammation of the testes

Question 4

Describe the pathophysiology of epididymo-orchitis?

Answer 4

• Local extension of infection from the bladder or urethra
• Either enteric (classic UTI) or non-enteric (STIs) organisms
  *

Question 5

What are the common causes of epididymo-orchitis in males <35 years old?

Answer 5

• Mechanism is likely sexual transmission
  
  • N. gonorrhoea
  • C. trachomatis
  • Males who practice anal intercourse: E. coli

Question 6

What are the common causes of epididymo-orchitis in males >35 years old?

Answer 6

• Usually enteric organism from a UTI
  
  • E. coli
  • Proteus spp.
  • Klebsiella pneumoniae
  • Pseudomonas aeruginosa

Question 7

Describe mumps orchitis?

Answer 7

• Complication of mumps viral infection
• Orchitis + fever, 4-8 days after onset of mumps parotitis
• Self-limiting disease
  
  • Can sometimes cause testicular atrophy and infertility
• If mumps is suspected, IgM/IgG serology should be measured
• Mumps is a notifiable disease in the UK

Question 8

Risk factors for epididymo-orchitis?

Answer 8

• Depends on mechanism of disease (STI/UTI)
• Non-enteric risk factors
  
  • MSM, multiple sexual partners, known gonorrhoea contact
• Enteric risk factors
  
  • Reducrrent catheterisation, bladder outlet obstruction, immunocompromised

Question 9

Clinical features of epididymitis?

Answer 9

• Unilateral scrotal pain assoc. with swelling
• Fever and rigors may also be present
• LUTS, dysuria, urethral discharge

Question 10

Signs of epididymitis on examination?

Answer 10

• Red and swollen scrotum
• Epididymis/testes will be tender on palpation
  
  • w/ associated hydrocele
• Intact cremasteric reflex
• Positive Prehn’s sign

Question 11

Describe Prehn’s sign?

Answer 11

• Patient lies supine
• Scrotum is elevated by examiner
• If pain is relieved by elevation = positive Prehn’s sign
  
  • suggestive of Epididymitis
• Not a very specific test

Question 12

Name some differentials for epididymitis?

Answer 12

• Testicular torsion
• Testicular trauma
• Testicular abscess
• Testicular tumour
• Hydrocoele

Question 13

Describe the investigations that should be performed for a suspected epididymitis?

Answer 13

• Urine dipstick + culture
• First void urine for NAAT (STI testing)
• FBC, CRP, blood cultures
• US doppler of testes

Question 14

Describe the management of epididymitis?

Answer 14

• Bed rest, antibiotics, analgesia
• Enteric: Levofloxacin, ofloxacin
• Non-enteric/STI: Ceftriazone + doxycycline (+Azithromycin if gonorrhoea likely)
  
  • Abstain from sex until antibiotic course is complete

Question 15

Complications of epididymitis?

Answer 15

• Reactice hydrocele formation
• Abscess formation
• Testicular infarction

Question 16

What blood test can confirm a new mumps infection?

Answer 16

IgM serology