Acute Epididymo-orchitis (Painful Scrotal Swelling)
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This is an inflammation of the epididymis and testis characterized by scrotal pain, tenderness and swelling of less than 6 weeks’ duration.
Causes
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STI-related Chlamydia trachomatis Neisseria gonorrhoeae Treponema pallidum |
Non-STI-related Testicular torsion Tuberculosis Mumps orchitis Tumours |
Signs and symptoms
- Fever
- Unilateral swelling and inflammation of the epididymis, +/- testicle
- Urethral discharge
- Increased frequency of micturition
- Hydrocele
- Scrotal pain
Complications
- Scrotal abscess and pyocele
- Fertility problems
- Testicular atrophy
Investigations
- Urinalysis
- Urine microscopy, culture and sensitivity
- Ultrasound scan of the scrotum
Treatment objectives
- Relieve pain
- Identify and treat underlying causes
Non-pharmacological treatment
- Bed rest
- Scrotal support until inflammation and fever subsides
Pharmacological treatment
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Sexually transmitted Chlamydia and Gonorrhoea: Ceftriaxone IM 250 mg as a single dose PLUS Doxycycline oral 100 mg two times daily for 10 days Sexually transmitted Chlamydia, Gonorrhoea and Enteric organisms (e.g. in men who practice insertive anal sex): Ceftriaxone 250 mg IM as a single dose PLUS Ciprofloxacin 500 mg two times daily for 10 days Enteric organisms: Ciprofloxacin 500 mg two times daily for 10 days For pain: Ibuprofen 400 mg two times daily for 10 days |
Referral If no improvement after the above treatment refer for specialist care