Epididymo-Orchitis,

Question 1

The epididymis is located on the testicles and functions to store sperm until they are mature enough to fertilise an egg. Epididymitis and orchitis is inflammation of the epididymis and orchi (testicle). What is the incidence of Epididymo-orchitis?

1 - 2 cases per 100,000
2 - 20 cases per 100,000
3 - 200 cases per 100,000
4 - 2000 cases per 100,000

Answer 1

3 - 200 cases per 100,000

Question 2

What age does the incidence of Epididymo-orchitis peak in?

1 - 5-10 years old
2 - 10-20 years old
3 - 20-30 years old
4 - 30-40 years old

Answer 2

3 - 20-30 years old

Epididymitis is the most common cause of scrotal pain in adults.

Question 3

Which of the following is NOT a risk factor for developing epididymo-orchitis?

1 - congenital abnormality reproductive tract
2 - age 20-29 years old
3 - increased sexual activity
4 - multiple sexual partners
5 - protection during sex
6 - anal sex

Answer 3

5 - protection during sex

In adult men, sex with a full bladder can cause reflux of infected urine from the prostatic urethra to the epididymis via the ejaculatory ducts and vas deferens

Question 4

In children which of the following could lead to Epididymo-orchitis?

1 - bladder outlet obstruction or a urethral stricture.
2 - ectopic ureter
3 - posterior urethral valves
4 - vesicoureteral reflux
5 - all of the above

Answer 4

5 - all of the above

Question 5

What is the most common cause of Epididymo-orchitis in men aged <35 years old?

1 - UTI
2 - STI
3 - Constipation
4 - fissure from GIT

Answer 5

2 - STI

Question 6

STI is the most common cause of Epididymo-orchitis in men aged <35 years old. Which 2 of the following organisms are most common?

1 - Chlamydia trachomatis
2 - Neisseria gonorrhoeae
3 - Escherichia coli
4 - Pseudomonas spp

Answer 6

1 - Chlamydia trachomatis
2 - Neisseria gonorrhoeae

Question 7

What is the most common cause of Epididymo-orchitis in men aged >35 years old and children?

1 - UTI
2 - STI
3 - Constipation
4 - fissure from GIT

Answer 7

1 - UTI

Question 8

UTI is the most common cause of Epididymo-orchitis in men aged <35 years old and children. Which 2 of the following organisms are most common?

1 - Chlamydia trachomatis
2 - Neisseria gonorrhoeae
3 - Escherichia coli
4 - Pseudomonas spp

Answer 8

3 - Escherichia coli
4 - Pseudomonas spp

Question 9

In addition to UTI and STI, all of the following can cause Epididymo-orchitis, EXCEPT which one?

1 - inguinal hernia
2 - trauma
3 - mumps virus
4 - medication (amiodarone)
5 - autoimmune disease

Answer 9

1 - inguinal hernia

Question 10

Is testicular torsion or Epididymo-orchitis more common in pre-pubertal men?

Answer 10

• testicular torsion

Question 11

Do the symptoms of epididymo-orchitis typically present in an acute or insidious manner?

Answer 11

• acute onset

Typically over a number of days

Question 12

Which of the following is NOT a typical sign of Epididymo-orchitis?

1 - bilateral scrotal pain
2 - groin pain
3 - swelling of the groin and scrotum
4 - sudden onset of symptoms

Answer 12

1 - bilateral scrotal pain

Typically unilateral, but in 5-10% of adults it can be bilateral

Question 13

Which 2 of the following could help identify that Epididymo-orchitis is caused by an STI?

1 - urethritis
2 - urethral discharge
3 - blood in urine
4 - anal fissure

Answer 13

1 - urethritis
2 - urethral discharge

Question 14

Which of the following could help identify that Epididymo-orchitis is caused by a UTI?

1 - polyuria
2 - dysuria
3 - urine urgency
4 - urinary retention
5 - abdominal pain
6 - dark, cloudy and smelly urine
7 - all of the above

Answer 14

7 - all of the above

Question 15

In a patient with suspected Epididymo-orchitis, we need to examine the scrotum while the patient is standing and lying down. All of the following may be observed EXCEPT which one?

1 - enlarged, erythematous scrotum
2 - tender to palpation on the affected side of the testis, epididymis or cord
3 - oedematous scrotum
4 - urethral discharge
5 - appendicitis
6 - secondary hydrocele, and pyrexia
7 - thickened and hard vas deferens

Answer 15

5 - appendicitis

May present with similar symptoms, but Epididymo-orchitis does not cause this

Question 16

A Prehn sign is when the patient feels relief of pain upon elevation of the scrotum. If there is relief of pain upon elevation of the scrotum, will this be more likely to be Epididymo-orchitis or testicular torsion?

Answer 16

Epididymo-orchitis

Does NOT rule out testicular torsion, if you suspect testicular torsion, then surgery needs to be performed asap

Question 17

All of the following would be performed if Epididymo-orchitis is suspected, EXCEPT which one?

1 - STI test
2 - ultrasound scan
3 - mid-stream urine analysis
4 - pelvic CT scan

Answer 17

4 - pelvic CT scan

Question 18

All of the following are likely differentials for Epididymo-orchitis, but which is the LEAST likely?

1 - testicular tumour
2 - testicular torsion
3 - hydrocele
4 - trauma

Answer 18

1 - testicular tumour

Possible, but would more likely cause a painless lump

Question 19

The cause of Epididymo-orchitis needs to be treated on an individualised basis. If an STI is suspected, which of the following should be used?

1 - BASHH recommendations for antibiotic treatment
2 - local guidelines for antibiotics
3 - wait and see approach
4 - admit to hospital

Answer 19

1 - BASHH recommendations for antibiotic treatment

BASHH guidelines:
- ceftriaxone 500mg IM
- doxycycline 100mg oral BD 10-14 days

CONTACT TRACING IS IMPORTANT AS WELL

Question 20

If the organism causing Epididymo-orchitis is unknown and patient presents acutely, which of the following would be most appropriate?

1 - 10 days of oral levofloxacin
2 - Referral for ultrasound scan (2 week wait)
3 - Single IM ceftriaxone and 10-14 days of doxycycline
4 - Single dose doxycycline and 10-14 days of ceftriaxone
5 - Urgent referral to urology for surgical intervention

Answer 20

3 - Single IM ceftriaxone and 10-14 days of doxycycline

Question 21

The cause of Epididymo-orchitis needs to be treated on an individualised basis. If a UTI is suspected, which of the following should be used?

1 - BASHH recommendations for antibiotic treatment
2 - local guidelines for antibiotics
3 - wait and see approach
4 - admit to hospital

Answer 21

2 - local guidelines for antibiotics

Typically oral quinolone for 2 weeks (e.g. ofloxacin)

Question 22

Following treatment for Epididymo-orchitis, either due to a UTI or STI, how lomg should patients seek medical advice if there is no improvement?

1 - 24h
2 - 3 days
3 - 5 days
4 - 7 days

Answer 22

2 - 3 days

Question 23

In Epididymo-orchitis, how long can the swelling in the testicles and groin take to return to normal?

1 - 12 weeks
2 - 6 weeks
3 - 2 weeks
4 - 24h

Answer 23

2 - 6 weeks

Can be quicker though

Question 24

Which of the following is NOT a complication of Epididymo-orchitis?

1 - reactive hydrocele.
2 - testicular tumour
3 - infertility or sub-fertility
4 - abscess formation and infarction of the testicle
5 - testicular atrophy

Answer 24

2 - testicular tumour