Epididymo-orchitis Flashcards
What is epididymitis?
Inflammation of the epididymis
Epididymitis often results from infection.
What is orchitis?
Inflammation of the testicle
Orchitis can be caused by infections such as mumps.
What does epididymo-orchitis refer to?
Inflammation of the epididymis and testicle on one side, usually due to infection
It commonly results from pathogens affecting both structures.
Name one common bacterial cause of epididymitis.
E. coli
Other causes include Chlamydia trachomatis and Neisseria gonorrhoea.
What are the clinical features of epididymitis?
Gradual onset of unilateral:
* testicular pain
* dragging or heavy sensation
* swelling of testicle and epididymis
* tenderness on palpation
* urethral discharge
* systemic symptoms (fever)
Symptoms can develop over minutes to hours.
What is a key differential diagnosis for epididymitis?
Testicular torsion
Testicular torsion is a urological emergency requiring rapid treatment.
What are the risk factors indicating a higher likelihood of STI in epididymitis patients?
- Age <35 years
- Increased number of sexual partners in last 12 months
- Discharge from urethra
These factors suggest a sexually transmitted infection as a potential cause.
What investigations are used for diagnosing epididymitis?
- Urine microscopy, culture and sensitivity (MC&S)
- Chlamydia and gonorrhoea NAAT test (first-pass urine)
- Charcoal swab of purulent urethral discharge
- Saliva swab if mumps suspected
- Ultrasound to assess for torsion or tumours
These tests help confirm the diagnosis and rule out other conditions.
What is the management for a patient with acute epididymitis who is very unwell or septic?
Admit to hospital for IV antibiotics
Immediate treatment is critical in such cases.
What should be done if there is a risk of STI as the cause of epididymitis?
Refer to genitourinary medicine (GUM) for assessment and treatment
This ensures appropriate management of potential STIs.
What antibiotics are recommended if E. coli is the causative organism?
- Ofloxacin for 14 days
- Levofloxacin for 10 days
- Co-amoxiclav for 10 days (if quinolones contraindicated)
Quinolones provide excellent gram-negative coverage but have critical side effects.
What are some additional measures in the management of epididymitis?
- Analgesia
- Supportive underwear
- Reduced physical activity
- Abstain from intercourse
These measures help alleviate symptoms and promote recovery.
What are potential complications of untreated epididymitis?
- Chronic pain
- Chronic epididymitis
- Testicular atrophy
- Sub-fertility or infertility
- Scrotal abscess
Complications can arise if the condition is not adequately treated.
