Epididymo-orchitis

Question 1

Definition of epididymo-orchitis

Answer 1

• Epididymitis – inflammation/infection of the epididymis
• Orchitis – inflammation/infection of the testes

Question 2

Causes of epididymo-orchitis

Answer 2

• E. coli
• Chlamydia trachomatis
• Neisseria gonorrhea
• Mumps

Question 3

Presentation of epididymo-orchitis

Answer 3

• Gradual onset over minutes/hours (as opposed to rapid onset with torsion)
• Usually unilateral
• Testicular pain and tenderness
• Dragging/heavy sensation
• Urethral discharge (think chlamydia/gonorrhoea)
• Tender on palpation, particularly over epididymis
• Swelling of testicle and epididymis
• Erythema to scrotum

NB - Don’t miss testicular torsion as a differential, if any doubt at all – treat as torsion

Question 4

Management of epididymo-orchitis

Answer 4

• Admit and treat sepsis if septic, otherwise as outpatient
• Antibiotics as per local guidelines
• Tight underwear for scrotal support during illness
• Abstain from intercourse during illness
• Confirm diagnosis with ultrasound of the scrotum (exclude torsion and tumours)