Epididymitis and orchitis

Question 1

Define them - UPDATE THIS PLS

Answer 1

Epididymitis - inflammation of the epididymis.
characterised by scrotal pain and swelling of less than 6 weeks’ duration. usually unilateral.

Orchitis - inflammation of the testes

The condition is referred to as acute epididymo-orchitis if concurrent inflammation of the testis is present.

Question 2

What is the aetiology of epididymitis?

Answer 2

most commonly caused by bacterial infection

In men >35 years, majority = non STI
common uropathogens;
such as Escherichia coli and Enterococcus faecalis .

Among men <35 years, infection is commonly transmitted via sexual intercourse
organisms; Chlamydia trachomatis and Neisseria gonorrhoeae.

Others;
Viral ; Mumps
Fungal; Candida if immunocompromised
1/3 are IDIOPATHIC

Question 3

Pathophysiology of epididymitis?

Answer 3

Retrograde ascent of urinary pathogens from the urethra and bladder, via the ejaculatory ducts and vas deferens, leads to colonisation and inflammation of the epididymis. The inflammatory process starts in the tail of the epididymis and subsequently spreads to the body and head of the epididymis

Question 4

Risk factors?

Answer 4

Diabetes

Rare: vasculitis (e.g. Henoch-Schonlein purpura)

Question 5

Epidemiology?

Answer 5

COMMON

Affects all age groups

Most commonly: 20-30 yrs

Question 6

Name some risk factors?

Answer 6

unprotected sex

bladder outflow obstruction

cather or other urine tract instrumentation

Question 7

Presenting symptoms?

Answer 7

Painful, erythematous, swollen hemiscrotum
Tender

swelling of gradual onset

enlargement of testis - orchitis included

NOTE: less acute onset than testicular torsion

Penile discharge; purulent suggest std

LUTS - if uti. so frequency, dysuria

possibly pyrexia - infectious cause

Question 8

Signs?

Answer 8

Swollen and tender epididymis or testis

Scrotum may be erythematous and oedematous

Pyrexia

Walking will be painful

Eliciting a cremasteric reflex may be painful ; stroking superior and medial part of thigh

Question 9

Investigations?

Answer 9

Urine;
(first void urine/ 1st one in morning)
Dipstick - positive leukocyte esterase/wbc = uti
MCS/Culture - causative organism
NAAT - nucleic acid amplification test (chlamydia trachomatis n gonorrhea)

Gram stain and culture of urethral secretions - usually gram negatives found (eg e.coli)

Others;
Imaging
1. enlarged hyperaemic epididymis on colour duplex ultrasonography
2. Surgical exploration where testicular torsion cannot be confidently excluded.

Question 10

Generate a management plan for epididymitis and orchitis

Answer 10

Anitbiotics!

Sexually transmitted;

1. Empirical ceftriaxone + doxycycline (if STI)
   - Plus paracetamol or nsaid
   - plus Levofloxacin if enteric infection

Not STI

1. Empirical quinolone - levofloxacin
   - Plus paracetamol or nsaid

Question 11

Complications and prognosis?

Answer 11

Abscess
Fournier’s gangrene (if the infection is left untreated and spreads)
Mumps orchitis could cause testicular atrophy and fertility issues

prognosis
GOOD if treated
May take up to 2 months for the swelling to resolve

Question 12

How does an epididymal cyst vary from epididymitis in presentation?

Answer 12

An epididymal cyst or spermatocele is a cyst of the head of the epididymis.

They are generally not painful.