epididymoorchitis

Question 1

what are the different causes?

Answer 1

STI-related: young, multiple partners, unprotected sex

Enteric-related: elderly, bladder outflow obstruction, instrumentation of urinary tract

Tuberculosis: can cause epididymo-orchitis

viral e.g. MUMPS

Question 2

how can it be distinguished from torsion?

Answer 2

prehns sign positive-> torsion is negative as pain is not relieved by lifting the testicle

cremestaric reflex is preserved, unlike in torsion

Question 3

what is the first line management for STI orchitis?

Answer 3

empirical: ceftriaxone 500 mg IM single dose and doxycycline 100mg BD for 10-14 days

Additional management: no sex until review and partner notification

Test of cure: only done in cases where gonorrhoea is confirmed

Question 4

what is the typical presentation for orchitis?

Answer 4

Unilateral tender, red, and swollen testicle
Pain develops over a few days
Lower urinary tract symptoms e.g. dysuria

Question 5

what is the first line management for enteric orchitis?

Answer 5

Empirical: fluoroquinolone e.g. Ofloxacin or ciprofloxacin for 10-14 days

Question 6

what are primary investigations for suspected orchitis?

Answer 6

Urinalysis: first void sample is most useful and should be sent for microscopy and culture. Neisseria gonorrhoeae is a gram-negative diplococcus, whilst chlamydia is difficult to gram stain

Nucleic Acid Amplification Test (NAAT): first void urine sample for NAAT to detect the DNA/RNA of the causative organism

Swab of urethral secretions: less sensitive than NAAT but must also be performed in symptomatic men

Question 7

what are complications of epididymooechitis?

Answer 7

Musculoskeletal: reactive arthritis secondary to chlamydia or gonorrhoea

Infective: disseminated infection secondary to gonorrhoea

Reproductive: male subfertility or infertility

Urological: epididymal obstruction and scarring secondary to poorly treated infection