Urology - Epididymo-orchitis Flashcards
Causes of epididymo-orchitis
E Coli
Chlamydia trachomatis
Neisseria gonorrhoea
Mumps
Presentation of epididymo-orchitis
Testicular pain
Dragging or heavy sensation
Swelling of testicle and epididymis
Tenderness on palpation, particularly over epididymis
Urethral discharge (should make you think of chlamydia or gonorrhoea)
Systemic symptoms such as fever and potentially sepsis
What is the key differential for epididymo-orchitis to think about?
Testicular torsion
What history questions should you ask for testicular problems?
Swelling of testicle
Lumps
Testicular pain
Dysuria
Urethral discharge - more likely STI cause of E-O
Systemic symptoms e.g. fever
Sexual history - any new sexual partners? Unprotected sexual intercourse?
Investigations in E-O
Urine microscopy, culture and sensitivity (MC&S)
Chlamydia and gonorrhoea NAAT testing on a first pass urine
Charcoal swab of purulent urethral discharge for gonorrhoea culture and sensitivities
Saliva swap for PCR testing for mumps, if suspected
Serum antibodies for mumps, if suspected (IgM – acute infection, IgG – previous infection or vaccination)
Ultrasound may be used to assess for torsion or tumours
Management of E-O
High risk of STI - refer urgently to GUM for assessment and treatment
Antibiotics as per local guidelines e.g. ofloxacin (for patients at low risk of STI)
Additional measures:
- Analgesia
- Rest/reduce physical activity
- Abstain from sex until the symptoms settle
What drug class of antibiotics are ofloxacin, levofloxacin and ciprofloxacin?
Quinolone antibiotics
What are some important side effects of quinolones that can occur?
Tendon damage and tendon rupture, notably in the Achilles tendon
Lower seizure threshold (caution in patients with epilepsy)
Potential complications of epididymo-orchitis?
Chronic pain Chronic epididymitis Testicular atrophy Sub-fertility or infertility Scrotal abscess
