urology

Question 1

What is epididymo-orchitis?

Answer 1

infection in the epididymis and testicle (usually on one side)

Question 2

What are the causes of epididymis?

Answer 2

• E.coli
• chlamydia trachomatis
• Neisseria gonnorrhoea
• Mumps

Question 3

Presentation of epididymo-orchitis?

Answer 3

gradual onset, with unilateral:

• testicular pain
• dragging or heavy sensation
• swelling of testicle and epidiymis
• tenderness on palpation
• urethral discharge
• fever and maybe sepsis

Question 4

diagnosis of epididymo-orchitis - what can possibly suggest a sexual cause and what investigations can be conducted?

Answer 4

Sexual - if under 36 years of age, increased numbe rof sexual partners and discharge

Investigations include:

• urine culture
• chlamydia and gonorrhoea NAAT testing on first pass urine
• Charcoal swab of discharge
• saliva swap for PCR for mumps
• serum antibodies for mumps
• Ultrasound

Question 5

Management of epididymo-orchititis?

Answer 5

IV antibiotics (Low risk of STI then typical choice is Ofloxacin for 14 days)

Alternatives:

• Levofloxacin/ciprofloxacin
• doxycycline
• Co-amoxiclav

NOTE: quinolones (ofloxacin, levofloxacin and anything ending with floxacin ) are poerful broad spec - used to treat UTI, pyelonephritis, emydidymo-orchitis anf prostatitis.

Question 6

What are the main two side affects of quinolones (ending in floxacin)

Answer 6

• tendon damage and tendon rupture, notably in Achilles tendon
• Lower seizure threshold (caution in patients with epilepsy)