(U)- Epididymo-orchitis

Question 1

What are the causes of epididymo-orchitis?

Answer 1

Escherichia coli
Chlamydia trachomatis
Neisseria gonorrhoea
Mumps

Question 2

How does epididymo-orchitis typically present?

Answer 2

Testicular pain
Dragging or heavy sensation
Swelling of testicle and epididymis
Tenderness on palpation
Urethral discharge
Systemic symptoms e.g. fever

Question 3

What is the key differential for epididymo-orchitis?

Answer 3

Testicular torsion

If any doubt treat as torsion until proven otherwise

Question 4

How can epididymo-orchitis be discriminated from testicular torsion?

Answer 4

Relief of pain on elevation

This is a positive Prehn’s sign, it is negative with testicular torsion

Cremasteric reflex

Question 5

What features of a history differentiate between STI or enteric organism as a cause of epididymo-orchitis?

Answer 5

Under 35
Increased number of sexual partners
Discharge from the urethra

Question 6

What investigations are used to diagnose epididymo-orchitis?

Answer 6

Urine microscopy, culture and sensitivity

Chlamydia and gonorrhoea NAATon a first-pass urine

Charcoal swab- purulent urethral discharge for gonorrhoea culture and sensitivities

Saliva swab- PCR for mumps

Serum antibodies- for mumps, if suspected (IgM- acute infection, IgG-previous infection or vaccination)

Ultrasound

Question 7

What is suggested by NICE for an enteric organism causing epididymo-orchitis?

Answer 7

Ofloxacin
14 days

Levofloxacin
10 days

Co-amoxiclav
10 days (when you cant use quinolones)

Question 8

What are two notable side effects of quinolone antibiotics such as ofloxacin, levofloxacin and ciprofloxacin?

Answer 8

Tendon damage and rupture (especially Achilles tendon)

Lowers seizure threshold (caution in patients with epilepsy)

Question 9

What are the complications of epididymo-orchitis?

Answer 9

Chronic pain
Chronic epididymitis
Testicular atrophy
Sub-fertility or infertility
Scrotal abscess