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Year 3 > Epididymitis & orchitis (URO) > Flashcards

Epididymitis & orchitis (URO) Flashcards

1
Q

What is epididymitis?

A

Inflammation of the epididymis characterised by scrotal pain and swelling of <6 weeks duration

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2
Q

What is the epididymis?

A

Cord that connects the testis with the ductus deferens

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3
Q

What are the main causes of epididymitis? (2 + 3)

A
  • UTI (older men and children) - E. coli (and other enteric pathogens)
  • STI (young males <35y):
    • Chlamydia trachomatis most common
    • Neisseria gonorrhoeae is second most common
    • Mycoplasma genitalium
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4
Q

What is orchitis?

A

Inflammation of the testis

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5
Q

What are the features of testicular torsion (differential for epididymitis)? (4)

A
  • age <20
  • severe pain
  • more acute onset
  • negative Prehn’s sign
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6
Q

What are some risk factors for epididymitis & orchitis? (8)

A
  • **unprotected sexual intercourse **(and MSM - anal intercourse)
  • bladder outflow obstruction (incomplete emptying = higher voiding pressures = reflux of infected urine into ductal system and spread of pathogens to epididymis)
  • instrumentation of urinary tract (cystoscopic procedures and urethral catheterisation)
  • immunosuppression
  • vasculitis
  • amiodarone
  • mumps
  • exposure to TB
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7
Q

What age group is most commonly affected by epididymitis?

A

20-30 years (most sexually active)

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8
Q

What are the features of mumps (risk factor for epididymitis/orchitis)? (4 + 2)

A
  • fever
  • malaise
  • muscular pain
  • parotitis (earache or pain on eating)
  • prevented via MMR vaccine, notifiable disease
  • complications: orchitis and pancreatitis
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9
Q

What are the clinical features of epididymitis? (5)

A
  • unilateral scrotal pain and swelling - gradual onset over several days, radiates to ipsilateral flank, <6 weeks, walking painful
  • tenderness (along posterior testis)
  • hot, erythematous, swollen hemiscrotum
  • frequent and painful micturition (LUTS)
  • purulent urethral discharge (STI) - found on primary catch urine sample
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10
Q

What is there a history of in epididymitis/orchitis? (2)

A
  • Sx of lower UTI - dysuria, frequency, urgency
  • Sx of STI - penile discharge
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11
Q

What are the clinical features of orchitis? (3)

A
  • sudden onset of nausea and vomiting
  • sudden fever
  • swollen and tender testicle/s - primarily unilateral
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12
Q

What might you see on examination in epididymitis/orchitis? (6)

A
  • positive Prehn sign - pain relief on elevation of scrotum/testes (testicular torsion will be -ve)
  • pyrexia
  • enlarged/tender prostate on DRE (bladder outflow obstruction)
  • epididymoorchitis: hot, enlarged, swollen, erythematous testis on one side
  • cremasteric reflex may be painful (cremasteric muscle contraction –> ipsilateral elevation of testicle)
  • inguinal lymphadenopathy
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13
Q

What are the first-line investigations for epididymitis? (4)

A
  • Gram stain and culture of urethral secretions
  • urine dipstick
  • urine MC&S
  • nucleic acid amplification test (NAAT) of urethral secretions/first-void urine for C. trachomatis, N. gonorrhoeae and M. genitalium
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14
Q

Why do we do urinalysis in epididymitis/orchitis?

A

To identify pyuria or bacteruria

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15
Q

What investigation is done to identify the causative agent for epididymitis in sexually active younger adults?

A

Nucleic acid amplification test (NAAT) of urethral secretions / first-void urine for C. trachomatis, N. gonorrhoeae and M. genitalium

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16
Q

What investigation is done to identify the causative agent for epididymitis in older adults with low-risk sexual history?

A

Urine culture (MSU for MC&S)

17
Q

What investigation is done in epididymitis/orchitis to rule out the most important differential diagnosis?

A

Duplex ultrasound of scrotum - rule out testicular torsion

18
Q

What are some differential diagnoses for epididymitis? (5)

A
  • testicular torsion:
    • sudden-onset, severe, unilateral scrotal pain
    • absence of Sx suggesting infection e.g. LUTS
    • negative Prehn’s sign
    • Ix: colour duplex USS
  • acute idiopathic scrotal oedema - paediatric, redness and oedema (painless)
  • infected hydrocoele
  • strangulated inguinal hernia
  • testicular tumour
19
Q

What supportive measures do we give in epididymitis/orchitis? (4)

A
  • NSAIDs
  • application of cold pack
  • bed rest
  • scrotal elevation (+ve Prehn’s sign)
20
Q

How would we go about treating the infection in epididymitis/orchitis?

A

Start empirical Abx based on the most likely causative organism, and adjust Abx therapy once causative organism identified

21
Q

What empirical Abx are given for epididymitis?

A

Ceftriaxone 500mg IM + oral doxycycline 100mg BD 10-14 days

22
Q

What Abx are given to treat epididymitis where gonorrhoea/chlamydia suspected?

A

Ceftriaxone + doxycycline

(+ azithromycin IF gonorrhoea is likely)

23
Q

What Abx are given to treat epididymitis where enteric organisms suspected?

A

Levofloxacin

24
Q

What Abx are given to treat epididymitis where Mycoplasma genitalium suspected?

A

Moxifloxacin

25
Q

What Abx are given to treat epididymitis if >35 years?

A

Mostly non-STI, associated UTI common = ciprofloxacin or ofloxacin

Avoid ciprofloxacin in patients with epilepsy

26
Q

Who else do we need to treat in epididymitis/orchitis?

A

Treat sexual partners

27
Q

What are some complications of epididymitis? (8)

A
  • epididymo-orchitis - spread of infection from epididymis to testicle
  • abscess formation (Abx, surgical drainage)
  • testicular ischaemia/infarction (occlusion/compression of BS –> testicular atrophy –> infertility - mumps orchitis)
  • epididymal obstruction (–> infertility)
  • chronic pain
  • male factor infertility
  • reactive hydrocoele
  • Fournier gangrene - acute necrotic infection of scrotum, penis or perineum
28
Q

What is the most common complication of mumps?

A

Orchitis

29
Q

What are some complications of orchitis? (2)

A
  • atrophy
  • hypofertility
30
Q

Describe the prognosis of epididymitis.

A

Symptoms usually resolve rapidly following initiation of appropriate Abx therapy

Year 3 (95 decks)

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