Epididymo-orchitis Flashcards
What is epididymo-orchitis?
Epididymo-orchitis describes an infection of the epididymis +/- testes resulting in pain and swelling.
What are the common causes of epididymo-orchitis?
It is most commonly caused by local spread of infections from the genital tract (such as Chlamydia trachomatis and Neisseria gonorrhoeae) or the bladder (E. coli).
In which population is Chlamydia trachomatis and Neisseria gonorrhoeae typically seen?
Typically seen in sexually active younger adults.
In which population is E. coli typically seen as a cause of epididymo-orchitis?
Typically seen in older adults with a low-risk sexual history.
What are the features of epididymo-orchitis?
Unilateral testicular pain and swelling; urethral discharge may be present, but urethritis is often asymptomatic.
What factors suggest testicular torsion?
Patients < 20 years, severe pain, and an acute onset.
What is the most important differential diagnosis for epididymo-orchitis?
The most important differential diagnosis is testicular torsion, which needs to be excluded urgently.
How are investigations for epididymo-orchitis typically guided?
Investigations are typically guided by the age of the patient.
What should be assessed in younger adults with suspected epididymo-orchitis?
Assess for sexually transmitted infections (STI).
What should be sent for microscopy and culture in older adults with low-risk sexual history?
Send a mid-stream urine (MSU) for microscopy and culture.
What is the management if an STI is the most likely cause?
Advise urgent referral to a local specialist sexual health clinic.
What is the recommended treatment if the organism is unknown?
BASHH recommends ceftriaxone 500mg intramuscularly single dose, plus doxycycline 100mg by mouth twice daily for 10-14 days.
What should be done if enteric organisms are the most likely cause?
Send an MSU as above and treat empirically with an oral quinolone for 2 weeks (e.g. ofloxacin).
What may be recommended following treatment for epididymo-orchitis?
Further investigations may be recommended to exclude any underlying structural abnormalities.
