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Flashcards in Epididymitis Deck (18)
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1

Epidemiology

Bimodal

15-30y

>60y

25 per 10000 people

2

Epididymitis vs Epididymo-orchitis

Classically the two conditions where thought to occur together

However most cases are solely epididymitis

Solo orchitis is very rare and mostly viral in origin

3

Pathophysiology

Local extension of infection from lower UT either via enteric or non-enteric organisms.

Non-enteric is usually STI

In males <35yo mostly likely organism is N. gonorrhoeae and C. trachomatis

In anal intercourse enteric like E.coli are also common causes

In >35 enteric is more common like E.coli Proteus, Klebsiella and Pseudomonas.

4

Risk factors

Non-enteric = Male to male sex, multiple sex partners, known contact of gonorrhoea

Enteric = recent instrumentation or cathetersisation, bladder outlet obstruction, immunocompromised

5

Clinical features

Unilateral scrotal pain + swelling

Fever and rigors might happens

Dysuria, storage LUTS, urethral discharge

6

Examination findings

Red and swollen

Testis might be very tender on palpation.

Might have hydrocoele

7

Specific tests

Cremasteric reflex should be intact in epididymitis

Prehn's sign +ve

8

Explain Prehn's sign

Patient is supine and scrotum is elevated.

If the pain is relieved by elevation = +ve

9

Dx

Testicular torsion

Testicular trauma

Testicular abscess

Epididymal cyst

Hydrocoele

Testicular tumour

10

Lab tests

Urine dipstick + Urine culture MC&S

Non-enteric => First void urine sent for NAAT

Further STI screening might be done

Routine bloods with FBC and CRP +/- blood cultures

11

Imaging

Diagnosis is typically clinical

USS can be done of the testes via US doppler to confirm diagnosis if needed or to rule out any complication like testicular abscess.

12

What will colour US doppler show in epididymitis?

Increased vascularity

13

Initial management

They can usually be treated as outpatient unless there is evidence of systemic infeciton, uncontrolled pain or warranting of further investigations.

14

First line treatment of enteric organisms

Ofloxacin 200mg PO BD for 14 days or Levofloxacin 500mg BD for 10 days

15

Non-enteric (STI) organism First line treatment

Ceftriaxone 500mg IM single dose and Doxycycline 100mg PO twice daily for 10-14 days (Add Azithromycin 1g PO single dose to that if gonorrhoea is likely)

16

Further management

Abstain from sexual activity until abx course is completed and symptoms have resolved

Advise on barrier contraception

Routine follow-up is not typically needed.

17

Complications

Symptoms should improve with 48h of starting abx

Reactive hydrocoele

Abscess formation

Testicular infarction

18