STI Syndromes

Question 1

What is epididymo-orchitis?

Answer 1

Inflammation of the epididymis, and occasionally the testis.

Question 2

What is the most common cause of epididymo-orchitis in people under 35 years?

Answer 2

Chlamydia trachomatis and occasionally Neisseria gonorrhoeae.

Question 3

In sexually active individuals of any age, what remains the most likely cause of epididymo-orchitis?

Answer 3

Chlamydia trachomatis and Neisseria gonorrhoeae.

Question 4

What pathogens are more likely to cause epididymo-orchitis in individuals who have insertive anal sex or recent instrumentation?

Answer 4

Enteric pathogens such as Escherichia coli and Proteus spp.

Question 5

What are some rarer causes of epididymo-orchitis?

Answer 5

• Paramyxovirus (mumps)
• Amiodarone use
• Tuberculosis
• Brucellosis
• Candida spp
• Cryptococcosis
• Behçet syndrome

Question 6

What non-STI causes may lead to epididymo-orchitis?

Answer 6

Presence of a urinary tract infection or prostatitis.

Question 7

What are the common symptoms of epididymo-orchitis?

Answer 7

• Scrotal pain and swelling
• Dysuria or urethral discharge
• Suprapubic pain, frequency, and nocturia

Question 8

What does unilateral swelling, induration, and tenderness of the epididymis indicate?

Answer 8

Epididymo-orchitis.

Question 9

What should be considered if there is very acute onset or severe pain in the scrotum?

Answer 9

Testicular torsion and urgent surgical referral.

Question 10

What investigations are performed for epididymo-orchitis?

Answer 10

• Physical examination
• Collect sample of urethral discharge for MC&S for gonorrheoa
• Collect first pass and mid-stream urine specimens for chlamydia
• Doppler ultrasonography if diagnosis is uncertain

Question 11

What is the recommended test for Chlamydia?

Answer 11

First pass urine = NAAT.

Question 12

What is the recommended test for Gonorrhoea?

Answer 12

First pass urine = NAAT.

Question 13

True or False: If the NAAT test result for Gonorrhoea is positive, a swab should be taken before treatment.

Answer 13

True.

Question 14

What is the management approach for sexually active men with suspected epididymo-orchitis?

Answer 14

Treat presumptively for gonorrhoea and chlamydia.

Question 15

What is the initial treatment for suspected Chlamydia or Gonorrhoea?

Answer 15

• Ceftriaxone 500mg IMI
• PLUS EITHER
  *Doxycycline 100mg PO BD for 14 days OR
  *Azithromycin 1g PO, stat and repeated 1 week later.

Question 16

What management is advised for men who engage in insertive anal sex with suspected epididymo-orchitis?

Answer 16

Treat empirically for gonorrhoea and chlamydia, considering alternative treatment if response is poor.

Question 17

What lifestyle advice should be given to patients post-treatment for epididymo-orchitis?

Answer 17

No sexual contact for 7 days after treatment starts or until symptoms resolve.

Question 18

What is recommended for sexual partners from the last 6 months if STI-related epididymo-orchitis is diagnosed?

Answer 18

All should be tested and treated.

Question 19

What should follow-up at 4-5 days after treatment involve?

Answer 19

• Assess treatment response
• Reassess test results
• Confirm partner management
• Provide sexual health education

Question 20

What is the recommended follow-up for men with chlamydia and gonorrhoea?

Answer 20

Retest for re-infection after 3 months.

Question 21

Fill in the blank: Severe pain and uncertain diagnosis may require _______ for urgent surgical assessment.

Answer 21

referral

Question 22

What may be necessary for confirmed urinary tract infections in men?

Answer 22

Further investigation or urological referral.