Epididymo-orchitis

Question 1

Epididymo-orchitis causes

Answer 1

• local spread of infection from genital
• often gonorrhoea or chlamydia
• can spread from bladder
• E.coli with low-risk sexual history

Question 2

Epididymo-orchitis presentation

Answer 2

• unilateral testicular pain and swelling
• may have urethral discharge or asymptomatic urethritis
• age <20, severe pain and acute onset suggest torsion

Question 3

Epididymo-orchitis investigations

Answer 3

• STI screen
• midstream urine sample - microscopy and culture
• testicular ultrasound

Question 4

Epididymo-orchitis management

Answer 4

• exclude testicular torsion
• refer to specialist sexual health clinic
• for unknown organisms: ceftriaxone 500mg IM single dose and doxycycline 100mg BD for 10-14 days
• for enteric organisms: oral quinolone for 2 weeks, e.g. ofloxacin