Urinary Tract Disease: Lower: Epididmo-Orchitis

Question 1

Definition

Answer 1

Inflammation of epididymis, extending to testes. Usually due to urethritis (STI) or cystitis (KEEPS) extension

Question 2

Epidemiology

Answer 2

Men
Urethritis <35
Cystitis >35
Elderly = catheter

Question 3

Signs and Symptoms

Answer 3

Unilateral scrotal pain + swelling = red and develops over a few days
LUTS: dysuria
Pyrexia may or may not be present
Prehn’s sign: Pain relieved with elevating testis
Cremaster reflex intact

Question 4

Differential diagnosis

Answer 4

Testicular torsion
- much more acute
- n + v
- cryptorchidism/ bell clapper
- prehns sign negative

Question 5

Diagnosis

Answer 5

NAAT
Urine dip = first void sample
MC + S

Question 6

Treatment

Answer 6

First-line for STI: 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
First-line for enteric organisms: fluoroquinolone e.g. Ofloxacin or ciprofloxacin for 10-14 days