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Epididymo-orchitis (EO) Flashcards

1
Q

Epididymo-orchitis - describe the clinical syndrome?

A

pain, swelling and inflammation of the epididymis +/- testes

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2
Q

Cause for EO can be categorised into 5 broad categories - what are they?

A 
Bacterial
Viral
Granulomatous
Other infective causes
Non-infective
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3
Q

What are the typical organisms implicated in bacterial EO?

A

Sexually transmitted
- chlamydia trachomatis
- neisseria gonorrhoea
Gram negative enteric organisms

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4
Q

What is used to differentiate between STI vs enteric organism risk for EO?

A

Age
BUT
important to take complete sexual history

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5
Q

What age is most commonly associated with STI EO?

A

<35

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6
Q

What other group are more at risk of enteric organism EO?

A

Men who have insertive anal sex

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7
Q

What increases the risk of enteric organism EO in all?

A

Recent instrumentation of GU tract

  • prostate biopsy
  • vasectomy
  • catheterisation
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8
Q

What proportion of men with anorectal malformations will develop EO?

A

20%

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9
Q

Is ureaplasma urealyticum a cause of EO?

A

Evidence lacking

Often found in association with chlamydia or gonorhoea

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10
Q

Is mycoplasma genitalium a cause of EO?

A

Evidence lacking

however biologically possible

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11
Q

There has been a case of PVL-staph aureus EO, how did the patient present?

A

Scrotal pain
Folliculitis with superficial abscess
Healthy individual

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12
Q

What is the most likely cause of viral induced EO?

A

Mumps

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13
Q

What proportion of post-pubertal males will develop EO from mumps?

A

40%

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14
Q

What is the main granulomatous disease to consider in EO?

A

TB

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15
Q

How common is TB EO?

A

Rare presentation

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16
Q

What people might get TB EO?

A

high prevalence countries
previous TB history
Immunodeficient
BCG instillation of bladder (increasingly reported)

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17
Q

Brucella, candida and schistosomiasis are all rare causes of EO, when should brucellosis be considered?

A

Patient from endemic area

  • Mediterranean
  • North & East Africa
  • Middle East
  • South & Central ASIA
  • Central & South America
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18
Q

What other symptoms may precede Brucella EO?

A

Fever, lethargy, night sweats

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19
Q

What non-infective causes have been implicated in EO?

A 
Behcet's disease
Amiodarone
Henoch-Schonlein Purpura (children)
Familial Mediterranean fever
Polyarteritis nodosa
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20
Q

What percentage of men with Behcet’s disease will develop EO?

A

12-19%

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21
Q

How does epididymo-orchitis typically present?

A

Acute onset
Unilateral scrotal pain
swelling
erythema

22
Q

What associated symptoms MAY occur with EO?

A 
urethritis
urethral discharge
fever
dysuria
frequency
urgency
23
Q

What is the MOST important differential to EO?

A

testicular torsion

24
Q

Who is most at risk of testicular torsion?

A

Neonate
Around puberty
BUT can occur any age

25
What are the typical symptoms of testicular torsion?
``` Sudden onset pain (within hours) Severe (typically) Radiates to GROIN or lower ABDOMEN Nausea or vomiting (associated) SIMILAR pain in past (intermittent torsion) ```
26
On clinical exam what may suggest testicular torsion?
Testis more tender than epididymis Swollen high riding horizontal torted testis
27
What is typically absent in torsion vs EO?
urethritis or evidence of UTI on preliminary tests
28
When can EO be treated and torsion disregarded as a differential?
When a diagnosis of EO can be clearly made
29
What specific features may suggest TB EO?
``` Subacute/chronic Painless or painful scrotal swelling (epididymus first) systemic symptoms of TB Scrotal sinus Thickened scrotal skin ```
30
What specific features may suggest Mumps EO?
Preceding: - headache - fever Then: unilateral or bilateral parotid swelling 7-10 days: unilateral testicular swelling epididymitis
31
What are the findings of EO on clinical examination?
Palpable UNILATERAL FIRM swelling and tenderness of the epididymus starting from TAIL at LOWER POLE of testis spreading to whole epididymis and testis
32
What complications may occur as a result of EO?
Reactive HYDROCELE ABSCESS formation INFARCTION of testicle INFERTILITY
33
Describe the relationship between EO and infertility?
Poorly understood | Mumps orchitis leads to testicular atrophy
34
What percentage of mumps orchitis will result in reduced fertility?
13% | with Bilateral orchitis
35
Who are more likely to experience complication of EO?
Patients with UROpathogen-related EO, NOT STI
36
What investigations are useful in work up of EO?
``` Microscopy for urethritis and GNDC FVU dipstick FVU NAAT Urethral swab culture MSSU Colour duplex US - for complications ```
37
Which investigation is indicated to exclude testicular torsion?
Surgical exploration ONLY | US will miss up to 3% cases in expert hands
38
Who should have referral to urologist in EO?
Possible testicular torsion | Urinary tract pathogen confirmed EO
39
What investigations should be considered for EO?
``` THREE early morning urines for AAFB IV urography Renal tract US (TB EO typically associated with renal tract pathology) Biopsy CXR ```
40
What percentage of patients with brucellosis develop EO?
20%
41
How do you confirm Brucella EO?
Brucella serology IgM & IgG
42
EO likely due to STI? Treatment?
Ceftriaxone 1g IM AND doxycycline 100mg twice daily 10-14 days
43
EO likely due to chlamydia or non-gonococcal STI? Treatment?
Doxycycline 100mg BD 10-14 days
44
EO likely due to enteric pathogen? Treatment?
Ofloxacin 200mg oral twice daily FOURTEEN days
45
EO likely due to chlamydia AND gonorrhoea AND enteric organism? Treatment?
Ceftriaxone 1g IM and OFLOXACIN 200mg BD 10 days
46
When should treatment for mycoplasma genitalium be given for EO?
If mycoplasma genitalium has been tested and identified
47
What is the treatment for mycoplasma genitalium EO?
Moxifloxacin 400mg once daily FOURTEEN days
48
What has been shown to have NO benefit in treatment of EO?
Corticosteroid
49
When will swelling in EO resolve following treatment?
3 months, 80% of cases
50
If little improvement in swelling or pain following treatment for EO what differentials should be considered?
Testicular ischaemia/infarction Testicular/epididymal tumour Progression to abscess Alternative infective causes - TB or mumps

DipGUM (39 decks)

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