Epidymitis and orchitis

Question 1

What is epididymtis and orchitis?

Answer 1

inflammation of the epididymis (epididymitis) or testes (orchitis)

Question 2

How is epididymtis and orchitis assoxiated with each other?

Answer 2

1. 60% of epididymitis is associated with orchitis

2. most cases of orchitis are associated with epididymitis

Question 3

What is it called when there is concurrent inflammation of epididymitis and orchitis?

Answer 3

epididymo-orchitis

Question 4

What are most cases caused by?

Answer 4

infective

Question 5

What is the likely infective organism if <35yrs?

Answer 5

Chlamydia trachomatis > Neisseria gonorrhoeae

Question 6

What is the likely infective organism if >35yrs?

Answer 6

mainly coliforms (eg , Klebsiella, E. coli, Enterococcus faecalis)

Question 7

What are 1/3 causes?

Answer 7

idiopathic

Question 8

What are RF for e coli infection?

Answer 8

1. Ladder outflow outbsutrction
2. UTI
   Ask about SxH: as RF is unprotected sex

Question 9

Why is immunosuppresion important to know?

Answer 9

Immunosuppression leads to colonisation of atypical organisms (candida)

Question 10

What are non-infective causes?

Answer 10

1. Trauma
2. Vasculitis (rare e.g. Behcets)
3. Medication e.g. amiodarone

Question 11

What are symptoms of Epidymitis and orchitis?

Answer 11

1. Painful
2. swollen, hot, tender erythematous scrotum
3. Unilateral
4. Dysuria
5. Urgency
6. Pyrexia

Question 12

Is the cremasteric reflex present?

Answer 12

yes and painful

Question 13

How acute is this?

Answer 13

1. Acute but less acute than testicular torsion (over few days)
2. Symptoms of the cause (penile discharge (STI)

Question 14

What is key difference between epidymtis and orchitis and testicular torsion?

Answer 14

• TT:
  1. high riding testicular
  2. absent cremasteric reflex
  3. hours
• E/o
  1. dysuria
  2. pyrexia
  3. penile discharge
  4. few days

Question 15

What bedside tests should be done for epidymtis and orchitis?

Answer 15

1. Urine Dipstick

2. MSU for MC&S – identify pathogen

Question 16

What bloods should be done for epidymtis and orchitis?

Answer 16

1. FBC – high WCC

2. U&Es

Question 17

What imaging should be done for epidymtis and orchitis?

Answer 17

(only done if unsure of diagnosis)

1. Colour Duplex USS
2. Surgical exploration may be done if testicular torsion cannot be excluded

Question 18

What is conservative management?

Answer 18

1. Bed rest

2. Scrotal elevation

Question 19

What is medical treatment?

Answer 19

1. Analgesia (paracetamol/ibuprofen)

2. Antibiotics to target infection

Question 20

What is surgical treatment?

Answer 20

1. Exploration of testes if testicular torsion cannot be excluded
2. Abscess drainage – if abscess develops