Epididymo-orchitis

Question 1

What is epididymo-orchitis?

Answer 1

Inflammation of the epididymis and testes on one side, presenting with acute scrotal pain

Question 2

What are the causes of epididymo-orchitis?

Answer 2

STI - chlamydia and gonorrhoea
UTI - E. coli
Mumps
TB

Question 3

What is the presentation of epididymo-orchitis?

Answer 3

Testicular pain
Dragging or heavy sensation
Swelling of testicle and epididymis
Tenderness on palpation
Urethral discharge (STI)
Systemic symptoms - fever
Prehn’s positive - lifting testicle relieves pain
Cremasteric reflex is intact

Question 4

What are the differentials of epididymo-orchitis?

Answer 4

Testicular torsion
Inguinal hernia
Testicular cancer

Question 5

What investigations can be carried out to help establish a diagnosis of epididymo-orchitis?

Answer 5

Urinalysis and urine culture
NAAT testing - chlamydia and gonorrhoea
Charcoal swab
Saliva swab - mumps
Scrotal ultrasound - rule out testicular torsion

Question 6

What is the management of epididymo-orchitis?

Answer 6

Analgesia
Scrotal elevation

If STI cause:
- 1g IM ceftriaxone and 100mg doxycycline BD for 10-14 days

If UTI cause:
- Ofloxacin for 14 days or levofloxacin for 10 days

Question 7

What are the complications of epididymo-orchitis?

Answer 7

Chronic pain
Chronic epididymitis
Testicular atrophy
Sub-fertility or infertility
Scrotal abscess