Epididymitis & Orchitis

Question 1

Definition

Answer 1

Inflammation of the epididymis or testes

o 60% of epididymitis is associated with orchitis
o Most cases of orchitis are associated with epididymitis

Question 2

Aetiology

Answer 2

• Most cases are INFECTIVE in origin

• Bacterial
o If < 35 yrs: Chlamydia and Gonococcus
o If > 35 yrs: mainly coliforms (e.g. Enterobacter, Klebsiella)
o RARE: TB, syphilis

• Viral
o Mumps

• Fungal
o Candida if immunocompromised

• 1/3 are IDIOPATHIC

Question 3

Risk factors

Answer 3

o Diabetes

o Rare: vasculitis (e.g. Henoch-Schonlein purpura)

Question 4

Epidemiology

Answer 4

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

Question 5

Presenting symptoms

Answer 5

• Painful, swollen and tender testis or epididymis
• Penile discharge
• NOTE: less acute onset than testicular torsion
• IMPORTANT: ask about sexual history

Question 6

Signs on physical examination

Answer 6

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

Question 7

Investigations

Answer 7

• Urine
o Dipstick
o Early morning urine collections for MC&S

• Bloods
o FBC - high WCC
o High CRP
o U&Es

• Imaging
o Increased blood flow on duplex examination

Question 8

Management plan

Answer 8

• Medical
o Antibiotics

• Surgical
o Exploration of testicles if testicular torsion cannot be excluded clinically
o Required if an abscess develops

Question 9

Possible complications

Answer 9

• Pain
• Abscess
• Fournier’s gangrene (if the infection is left untreated and spreads)
• Mumps orchitis could cause testicular atrophy and fertility issues

Question 10

Prognosis

Answer 10

• GOOD if treated

* May take up to 2 months for the swelling to resolve