Acute Epididymo-orchitis

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This is an inflammation of the epididymis and the testes. It is usually a complication of urethritis which is not treated at all or which was improperly treated.

Clinical Features Presentation is mucoid, puss-filled urethral discharge, painful scrotal swelling usually unilateral but could be bilateral, the pain is gradual and dull. Milking of the urethra produces puss-filled discharge. Diagnosis is confirmed by culture of urethral discharge. Complications include atrophy of the testes, infertility.

Supportive

• Bed rest,
• Scrotal support or elevation,
• Scrotal ice packs,
• Analgesia

Treatment

The causative organism in men less than 35 years of age is usually Neisseria gonorrhoeae or Chlamydia trachomatis.

Drugs
The best antibiotics are those that are sensitive to the above organisms.
Ciprofloxacin 500mg stat oral + Doxycycline 100 mg OD for 7 days.
OR
Ceftriaxone 1g (I.M.) once + Doxycycline 100mg 12 hourly for 7 days.

Erythromycin may be substituted for Tetracycline or Doxycycline at 500mg every 6 hours for 7 days.

In men older than 35 years of age, the cause is mostly due to coliform gram-negative bacilli. Gentamicin 80mg 8 hourly for 7 days or a 3rd generation cephalosporine as above may be used until the sensitivity is determined.

Prevention

• Avoiding multiple sexual partners
• Usage of condoms.