Epididymo-orchitis

Question 1

Definition of epididymo-orchitis

Answer 1

Inflammation of the epididymis and/or the testes (can be described as epididymo-orchitis). It is characterised by scrotal pain and swelling of less than 6 weeks duration

Question 2

Aetiology of epididymo-orchitis

Answer 2

• Usually has an INFECTIVE (infection from genital tract) cause:
• BACTERIAL:
• If <35 years old: CHLAMYDIA trachomatis, Neisseria gonorrhoeae are the most common causes of epididymitis (typically seen in sexually active adults)
• If >35 years old: likely non-sexual infection (from bladder) (E.coli, TB (rarer))

• VIRAL: (more rare)
◦ Mumps
• Non infectious causes too

Question 3

Pathophysiology of epididymo-orchitis

Answer 3

• Occurs due to ascent of urinary pathogens from the urethra and bladder to the epididymis
• Starts at the tail of the epididymis and then goes to body and head
• In many cases, the TESTES are involved, leading to epididymis-orchitis

Question 4

History and Examination of epididymo-orchitis

Answer 4

• Unilateral scrotal pain and swelling of gradual onset: typically occurs over a few days, as opposed to testicular torsion (occurs suddenly and is MAIN DIFFERENTIAL)
• Symptoms <6 weeks
• Tenderness: upon palpation of the epididymis
• Hot, erythematous, swollen hemiscrotum: unilateral pain and swelling of testicle
• Purulent urethral discharge
• Dysuria

Question 5

Risk factors for epididymo-orchitis

Answer 5

• Age 19-25
• Multiple sex partners (sexual history very important)
• Unprotected sexual intercourse
• Bladder outflow obstruction (in older men)
• Anal intercourse

Question 6

Investigations for epididymo-orchitis

Answer 6

• Urine dipstick: first-void urine would show positive for WBC (suggests lower urinary tract infection)
• Urinary microscopy
• Urine culture: take midstream to isolate pathogens
• Gram stain of urethral secretions
• (Assess for STIs)

Question 7

Treatment of epididymo-orchitis

Answer 7

Bacterial infection:
1) Antibiotic therapy:
◦ Sexually active males should be screened for STIs
◦ They should be treated empirically with CEFTRIAXONE and DOXYCYCLINE (covers gonorrhoea and chlamydial infection respectively)
◦ Add azithromycin if gonorrhoea is very likely
◦ Should be used for 2-4 weeks

+Supportive measures: Bed rest and scrotal elevation. Analgesics can be used too

Question 8

Prevention and prognosis of epididymo-orchitis

Answer 8

• Use protection to reduce risk of STI transmission

Infectious epididymitis symptoms usually resolve rapidly following prompt initiation of antibiotic therapy
Inadequately treated epididymitis can lead to epididymal obstruction or testicular atrophy

Question 9

Complications of epididymo-orchitis

Answer 9

• Abscess formation: surgical drainage would be needed. Prompt antibiotic treatment would reduce risk of this
• Epididymal obstruction or testicular atrophy: if not treated appropriately, can lead to infertility