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DipGUM > Epididymo-orchitis (EO) > Flashcards

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
Q

What are the typical symptoms of testicular torsion?

A 
Sudden onset pain (within hours)
Severe (typically)
Radiates to GROIN or lower ABDOMEN
Nausea or vomiting (associated)
SIMILAR pain in past (intermittent torsion)
26
Q

On clinical exam what may suggest testicular torsion?

A

Testis more tender than epididymis
Swollen
high riding
horizontal torted testis

27
Q

What is typically absent in torsion vs EO?

A

urethritis or evidence of UTI on preliminary tests

28
Q

When can EO be treated and torsion disregarded as a differential?

A

When a diagnosis of EO can be clearly made

29
Q

What specific features may suggest TB EO?

A 
Subacute/chronic
Painless or painful
scrotal swelling (epididymus first)
systemic symptoms of TB
Scrotal sinus
Thickened scrotal skin
30
Q

What specific features may suggest Mumps EO?

A

Preceding:

  • headache
  • fever

Then:
unilateral or bilateral parotid swelling

7-10 days:
unilateral testicular swelling
epididymitis

31
Q

What are the findings of EO on clinical examination?

A

Palpable UNILATERAL FIRM swelling and tenderness of the epididymus starting from TAIL at LOWER POLE of testis spreading to whole epididymis and testis

32
Q

What complications may occur as a result of EO?

A

Reactive HYDROCELE
ABSCESS formation
INFARCTION of testicle
INFERTILITY

33
Q

Describe the relationship between EO and infertility?

A

Poorly understood

Mumps orchitis leads to testicular atrophy

34
Q

What percentage of mumps orchitis will result in reduced fertility?

A

13%

with Bilateral orchitis

35
Q

Who are more likely to experience complication of EO?

A

Patients with UROpathogen-related EO, NOT STI

36
Q

What investigations are useful in work up of EO?

A 
Microscopy for urethritis and GNDC
FVU dipstick
FVU NAAT
Urethral swab culture
MSSU
Colour duplex US - for complications
37
Q

Which investigation is indicated to exclude testicular torsion?

A

Surgical exploration ONLY

US will miss up to 3% cases in expert hands

38
Q

Who should have referral to urologist in EO?

A

Possible testicular torsion

Urinary tract pathogen confirmed EO

39
Q

What investigations should be considered for EO?

A 
THREE early morning urines for AAFB
IV urography
Renal tract US (TB EO typically associated with renal tract pathology)
Biopsy
CXR
40
Q

What percentage of patients with brucellosis develop EO?

A

20%

41
Q

How do you confirm Brucella EO?

A

Brucella serology IgM & IgG

42
Q

EO likely due to STI? Treatment?

A

Ceftriaxone 1g IM AND doxycycline 100mg twice daily 10-14 days

43
Q

EO likely due to chlamydia or non-gonococcal STI? Treatment?

A

Doxycycline 100mg BD 10-14 days

44
Q

EO likely due to enteric pathogen? Treatment?

A

Ofloxacin 200mg oral twice daily FOURTEEN days

45
Q

EO likely due to chlamydia AND gonorrhoea AND enteric organism? Treatment?

A

Ceftriaxone 1g IM and OFLOXACIN 200mg BD 10 days

46
Q

When should treatment for mycoplasma genitalium be given for EO?

A

If mycoplasma genitalium has been tested and identified

47
Q

What is the treatment for mycoplasma genitalium EO?

A

Moxifloxacin 400mg once daily FOURTEEN days

48
Q

What has been shown to have NO benefit in treatment of EO?

A

Corticosteroid

49
Q

When will swelling in EO resolve following treatment?

A

3 months, 80% of cases

50
Q

If little improvement in swelling or pain following treatment for EO what differentials should be considered?

A

Testicular ischaemia/infarction
Testicular/epididymal tumour
Progression to abscess
Alternative infective causes - TB or mumps

DipGUM (39 decks)

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