Epididymo-orchitis

Question 1

What is Epididymo-orchitis?

Answer 1

Inflammation of the epididymis and testicle.

Question 2

What is Epididymo-orchitis due to?

Answer 2

Local spread of infection from the genital tract or bladder

Question 3

Who is usually affected by Epididymo-orchitis?

Answer 3

Adult males

Question 4

What are the main causes of Epididymo-orchitis if it presents in a sexually active young persion?

Answer 4

Chlamydia trachomatis and Neisseria gonorrhoeae

Question 5

What is the main cause of epididymo-orchitis if it presents in an older person with a lesser sexual activity history?

Answer 5

E.coli

Question 6

What are the main presenting features of epididymo-orchitis?

Answer 6

• unilateral testicular pain and swelling
• frequency and dysuria may be present
• Potenitally pyrexia

Question 7

What might you see on examination of someone with epididymo-orchitis?

Answer 7

Swollen and tender testis with the treated swelling located over the epididymis

Question 8

What is the most common cause of epididymo-orchitis?

Answer 8

E.coli

Question 9

What is the most important differential diagnosis to epididymo-orchitis?

Answer 9

Testicular torsion

Question 10

What is the maagement of it is likely an STI causing the epididymo-orchitis?

Answer 10

Ceftriaxone 500mg intramuscularly single dose, plus doxycycline 100mg by mouth twice daily for 10-14 days

Question 11

What is the managment if E.coli is the likely cause of epididym-orchitis?

Answer 11

Oral quinolone for 2 weeks (e.g. ofloxacin)

Question 12

If ther was discharge in someone with epididymo-orchitis, what woud be the likely cause?

Answer 12

Chlamydia or gonorrhoea

Question 12

If ther was discharge in someone with epididymo-orchitis, what woud be the likely cause?

Answer 12

Chlamydia (main) or gonorrhoea

Question 13

What investigations can be carried out in someone with epididymo-orchitis?

Answer 13

MSSU: E.coli
NAAT: Chlamydia

Question 14

What are examples of quinolones that can be prescribed for e.coli caused epididymo-orchitis?

Answer 14

Ofloxacin for 14 days
Levofloxacin for 10 days

Question 15

What are possible side effects of quinolones?

Answer 15

Tendon damage and tendon rupture, notably in the Achilles tendon
Lower seizure threshold (caution in patients with epilepsy)

Question 16

Example of someone presenting with epididymo-orchitis?

Answer 16

One-sided groin pain and scrotal swelling with associated dysuria
Hemiscrotum is erythematous and tender.
Pyrexia
Elevation of the scrotal skin eases the pain.

Question 17

What can help reduce the pain in someone with epididymo-orchitis?

Answer 17

Elevation of the scrotal skin eases the pain

Question 18

How is the presenation different to testicular torsion?

Answer 18

Testicular torsio has a more acute onset- within hours
Epididymo-orchitis- onset over a few days