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