Epididymitis and orchitis

Question 1

Define epididymitis

Answer 1

infection or (less frequently) inflammation of the epididymis (coiled tube on the back of the testicle)

Question 2

Define orchitis

Answer 2

inflammation of one or both testicles

Question 3

Aetiology of epididymitis

Answer 3

Bacterial infection
If sexually active, these bacteria are: 
	Neisseria gonorrhoeae
	Chlamydia trachomatis
	Coliform bacteria 
•	Which cause urethritis then ascend 

In older men and children:
E.Coli and TB

Question 4

Aetiology of orchitis

Answer 4

Occurs with epididymitis but can have its own causes
o	Mumps
o	M. tuberculosis
o	Syphilis
o	AI (granulomatous orchitis)

Question 5

RFs of epididymitis and orchitis

Answer 5

•	Sexually active
•	Unprotected sexual intercourse
•	Bladder outflow obstruction
•	Instrumentation of the urinary tract
•	Immunosuppression
•	Mumps
•	Amiodarone (antiarrhythmic)
o	Causes inflammation by accumulating in high concentration in the epididymis

Question 6

Epidemiology of epididymitis and orchitis

Answer 6

Any age group
• 30% of post-pubertal males infected with mumps get orchitis
o Usually 3-4 days after onset of parotitis
o 10-30% are bilateral

Question 7

Presenting symptoms of epididymitis

Answer 7

•	Scrotal pain 
o	May radiate to the groin (spermatic cord) and lower abdomen
o	Gradual onset (few days)
•	Unilateral swelling
o	Gradual onset (few days)
•	Symptoms of infection
o	FUND
o	Frequent, painful urination
o	Purulent urethral discharge

Question 8

Presenting symptoms of orchitis

Answer 8

•	Testicular pain
o	From mild discomfort to severe
•	Testicular swelling
•	Associated systemic symptoms
o	Fatigue and malaise
o	Fever and chills
o	Nausea
•	Parotitis (begins 4-7 days before)

Question 9

signs of epididymitis

Answer 9

• Testicular swelling
• Testicular tenderness
• Scrotal skin erythema
• Thickening of spermatic cord
• Reactive hydrocele

Question 10

Signs of orchititis

Answer 10

•	Fever
•	Testicular swelling
•	Testicular tenderness
•	Scrotal skin erythema
•	Associated enlarged epididymis
•	Signs of cause
o	Parotitis

Same as epididymitis tbh

Question 11

investigations for epididymitis and orchitis

Answer 11

First catch urine sample
o Dipstick: Positive leukocyte esterase
o MC+S: WBCs
Urethral discharge swab
o MC+S: Positive for N. gonorrhoeae or Chlamydia
STI screen
Bloods
o CRP/ESR
Colour Doppler = important
o Rule out testicular torsion (normal sized testicle with decreased flow)
o Enlarged epididymis with thickening and increased flow

Question 12

How to manage epididymitis?

Answer 12

o	Supportive measures
	Analgesia
	NSAIDs
	Bed rest
	Scrotal support/elevation
o	IF under 35 – likely STI
	Chlamydia: Doxycycline PO 100mg
	Gonorrhoea: Ceftriaxone IM single dose
•	If unsure, begin with both
o	IF over 35 – unlikely STI
	Ciprofloxacin = quinolone
o	IF caused by amiodarone	
	Stop amiodarone

Question 13

Managing orchitis?

Answer 13

o	Supportive measures
	Bed rest
	Analgesia
	Scrotal elevation
	Hot/cold packs for analgesia
o	Treat cause
	IF epididymo-orchitis
•	Initiate appropriate ABs
	IF mumps
•	No treatment needed
o	Usually resolve spontaneously in 3-10 days

Question 14

Possible complications of epididymitis?

Answer 14

• Abscess formation
• Testicular ischaemia/infarction
• Epididymal obstruction
• Chronic pain
• Infertility

Question 15

Possible complications of orchitis?

Answer 15

• Infertility (10%)
• Testicular atrophy (60%)
• Hydrocele
o May require surgical drainage

Question 16

Prognosis of epididymitis?

Answer 16

IF acute infectious, symptoms usually resolve rapidly with appropriate treatment
o However rapid improvement can lead to non-adherence and recurrence
• Inadequate treatment can lead to complications

Question 17

Prognosis of orchitis?

Answer 17

• Most spontaneously resolve in 3-10 days

* Most bacterial cases resolve without complications with AB coverage