epidymo-orchitis

Question 1

what is the most common cause in men <35?

in men >35? what is the risk?

what normally vaccinated against organism can cause this?

Answer 1

• chalmydia
• neiseirra gonorrhoea
• E.coli
• pseudomonas (gram neg enteric organism causing UTI)
• mumps
• Also TB epididymitis

Question 2

what is a risk factor for non STI causing organisms?

Answer 2

• structural/ functional abnormalities of urinary tract are common
• adults usually have bladder outlet obstruction or a urethral stricture
• children: posterior urethral valves or vesico-ureteric reflux

Question 3

how might they present?

Answer 3

• usually unilateral scrotal pain and swelling of acute onset
• urethral discharge= STI
• UTI symptoms
• palpation produces pain, swelling of epididymis

Question 4

what is an important differential to rule out?

Answer 4

• testicular torsion

- painful swollen testicle in a young male should be treated as torsion until proven otherwise (more acute history)

Question 5

what other differentials are there for acute scrotal pain?

Answer 5

• hydrocele
• tumour
• trauma
• abscess formation

Question 6

what investigations would you perform?

Answer 6

• gram staining of urethral swab (gram neg diplococci)
• NAAT testing for gonorrhoea
• consider HIV testing
• colour doppler ultrasound: rule out torsion

Question 7

what antibiotics should be given if it is gonorrhoea?

if it is an enteric cause?

Answer 7

• ceftriaxone 250mg IM
• doxycycline 100mg 7-14 days
• 200mg BD oral