Acute Epididymo-orchitis
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This is an acute inflammation of the epididymis and testis usually due to a bacterial infection. It may follow ascending infection from the urethra (including STIs), instrumentation/catheterization, untreated lower urinary tract obstruction and genito-urinary surgery. It is a known complication of mumps. Poorly managed acute epididymo-orchitis may be complicated by septicaemia, abscess formation, chronic epididymo-orchitis, secondary hydrocoele, infertility and Fournier’s gangrene.
Before managing as acute epidymoorchitis make sure testicular torsion has been conclusively excluded.
Cause
- Mumps virus (orchitis)
- Escherichia coli
- Chlamydia
- Gonococcus
- Staphylococcus
- Streptococcus
- Pseudomonas
- Mycobacterium tuberculosis
Symptoms
- Fever
- Scrotal/testicular pain
- Scrotal swelling
- Urethral discharge
- Dysuria
- Malaise
Signs
- Fever
- Tender and swollen hemiscrotum
- Inflamed epididymis and testis
- Secondary hydrocoele
- Positive Prehn’s sign (lifting of scrotum towards pubic symphysis in the palm relieves pain)
Investigations
- Urinalysis
- Urine culture and sensitivity - first catch of urine preferred to midstream urine
- FBC and ESR
- Blood culture and sensitivity
- Scrotal ultrasound/MRI
TreatmentTreatment Objectives
- To relieve symptoms
- To eradicate the infection
- To prevent recurrence
- To prevent complications e.g. abscess and sterility
Non-pharmacological treatment
- Bed rest
- Scrotal support
- Surgical drainage of abscess
- Avoid unprotected sex until treatment has been completed successfully and follow up counseling.
- Trace and treat sexual contacts
Pharmacological treatment
1st Line Treatment
- Ciprofloxacin, oral,
Adult
500 mg 12 hourly for 14 days
Children
5-15 mg/kg 12 hourly for 14 days
And
- Doxycycline, oral, 100 mg 12 hourly for 4 weeks in cases of sexually transmitted infections
Or
- Azithromycin, oral,
Adult
500 mg daily for 3 days
Children
10 mg/kg daily for 3 days
2nd Line treatment
- Norfloxacin, oral, 400 mg 12 hourly for 14 days
And
- Doxycycline or Azithromycin (as above in 1st Line Treatment).
Or
- Levofloxacin, 500 mg daily for 14 days
And
- Doxycycline or Azithromycin (as above in 1st Line Treatment)
And
- Diclofenac sodium, oral, 50 mg 8 hourly
Or
- Ibuprofen, oral, 400 mg 8 hourly
Referral Criteria
- Refer all cases of persistent fever and complications to the surgical specialist or urologist