Acute Epididymo-orchitis

Acute Epididymo-orchitis 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.

Causes of Acute Epididymo-orchitis

  1. Mumps virus (orchitis)
  2. Escherichia coli
  3. Chlamydia
  4. Gonococcus
  5. Staphylococcus
  6. Streptococcus
  7. Pseudomonas
  8. Mycobacterium tuberculosis

Symptoms of Acute Epididymo-orchitis

  • Fever
  • Scrotal/testicular pain
  • Scrotal swelling
  • Urethral discharge
  • Dysuria
  • Malaise

Signs of Acute Epididymo-orchitis

  • Fever
  • Tender and swollen hemiscrotum
  • Inflamed epididymis and testis
  • Secondary hydrocoele
  • Positive Prehn’s sign (lifting of scrotum towards pubic symphysis 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

Treatment of Acute Epididymo-orchitis

Treatment objectives

  1. To relieve symptoms
  2. To eradicate the infection
  3. To prevent recurrence
  4. To prevent complications e.g. abscess and sterility

Non-pharmacological treatment

  1. Bed rest
  2. Scrotal support
  3. Surgical drainage of abscess
  4. Avoid unprotected sex until treatment has been completed successfully and follow up counseling.
  5. 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 1″ 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.