Epididymitis and orchitis

Question 1

Basic anatomy

Answer 1

At the back of each testicle is the epididymis

Sperm released from testicle into head of epididymis, connected at the top of the testicle

Sperm travel through the head, then the body, then the tail of the epididymis

Sperm mature and are stored in the epididymis

Epididymis drains into vas deferens

Question 2

Causes

Answer 2

E.coli

Chlamydia

Gonorrhoea

Mumps

Question 3

Features

Answer 3

Unilateral testicular pain and swelling

Urethral discharge may be present

Dragging or heavy sensation

Tenderness on palpation

Systemic infective symptoms

Question 4

Key differntial

Answer 4

Testicular torsion needs to be excluded urgently to prevent ischaemia of the testicle

Question 5

Investigations

Answer 5

Urine MC&S

Chlamydia and gonorrhoea NAAT testing on first-pass urine

Charcoal swab of purulent discharge for gonorrhoea and sensitivities

Saliva swab for PCR testing for mumps

Serum antibodies for mumps

US to assess for torsion or tumours

Question 6

Management

Answer 6

Unknown organism: ceftriaxone and doxycycline

E.coli: ofloxacin/ levofluxacin/ co-amoxiclav

Additional measures
- analgesia
- supportive underwear
- reduced physical activity
- abstain from intercourse

Question 7

Complications

Answer 7

Chronic pain

Chronic epididymitis

Testicular atrophy

Sub-fertility/ infertility

Scrotal abscess