epidymitis + orchitis Flashcards
what is epididymo-orchitis?
Epididymo-orchitis is a clinical condition characterised by inflammation of the epididymis and the testicle.
who is EO seen in?
sexually active males, aged 19-35yrs
what causes EO?
commonly: Sexually transmitted infections, notably chlamydia (commonest cause in those <35) and gonorrhoea
Urinary tract infections, with E. coli being the predominant causative organism in older adults (>35)
less common causes of EO?
Mumps
Tuberculosis
features of EO?
acute scrotal pain
Testicular swelling and tenderness
Fever
Dysuria (painful urination)
Urethral discharge
Prehn’s positive (lifting up testicle relieves pain due to inflammation)
Cremasteric reflex is intact (this helps differentiate clinically from torsion)
ix for EO?
Clinical history and physical examination
Urinalysis and urine culture to identify urinary tract infections
Sexually transmitted infection screening via nucleic acid amplification tests (NAATs)
Urethral swab and gram stain can also be performed. If this reveals an intracellular organism Chlamydia is the likely cause, and if it shows grame negative diplococci this suggests Gonorrhoea.
Scrotal ultrasound may be needed to rule out testicular torsion
conservative for OE?
Symptomatic management with analgesics for pain relief
Scrotal elevation and rest
abx for EO?
High risk for STI: treat empirically with oral doxycycline for 10–14 days, and a single dose of IM ceftriaxone if gonorrhoea is suspected. Referral to sexual health clinic and contact tracing are likely necessary.
If an enteric organism (e.g. E.coli), or UTI is the most likely cause: treat with levofloxacin (10 days) or ofloxacin (14 days). If either of these are contraindicated/not tolerated, co-amoxiclav can be used.
when should EO be reviewed?
Review after 2 weeks - if ongoing symptoms consider ultrasound imaging +/- urology referral
