25 per 10000 people
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
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.
Non-enteric = Male to male sex, multiple sex partners, known contact of gonorrhoea
Enteric = recent instrumentation or cathetersisation, bladder outlet obstruction, immunocompromised
Unilateral scrotal pain + swelling
Fever and rigors might happens
Dysuria, storage LUTS, urethral discharge
Red and swollen
Testis might be very tender on palpation.
Might have hydrocoele
Cremasteric reflex should be intact in epididymitis
Prehn's sign +ve
Explain Prehn's sign
Patient is supine and scrotum is elevated.
If the pain is relieved by elevation = +ve
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
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.
What will colour US doppler show in epididymitis?
They can usually be treated as outpatient unless there is evidence of systemic infeciton, uncontrolled pain or warranting of further investigations.
First line treatment of enteric organisms
Ofloxacin 200mg PO BD for 14 days or Levofloxacin 500mg BD for 10 days
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)
Abstain from sexual activity until abx course is completed and symptoms have resolved
Advise on barrier contraception
Routine follow-up is not typically needed.
Symptoms should improve with 48h of starting abx