Epididymo-orchitis

Epididymo-orchitis is a clinical syndrome consisting of pain,
swelling and inflammation of the epididymii and testes.
Most commonly, epididymo-orchitis results from infection
spreading via the urethra or the bladder. In sexually active
men < 35 years Chlamydia trachomatis and Neisseria
gonorrhoeae spreading from the urethra are the most
common causes. Epididymo-orchitis in men > 35 years is
more commonly due to Gram negative organisms (such
as pseudomonas, proteus and E. coli) spreading from the
bladder as a result of a urinary tract infection (UTI). Men who
practice insertive anal sex may present with epididymoorchitis
caused by these Gram negative organisms.

The patient will always have scrotal pain and swelling,
usually unilateral.
Symptoms of urethritis or urinary tract infection may or
may not be present.

Swollen testicle or epididymis
Tenderness to palpation on affected side
Other possible examination findings are:
Urethral discharge – commonly absent
Scrotal erythema or oedema on the affected side
Fever

If urethral discharge is present a swab should be taken
for Gram stain.
Urethral swab or first void urine tests for chlamydia and
gonorrhoea
MSU for microscopy, culture and sensitivities
If clinically suspected consider tests for mumps virus and
tuberculosis.

Pain relief, rest and scrotal support
Antibiotics should aim to cover the most likely causes:
If most likely to be related to STI treatment should be:
Azithromycin 1 g single dose PLUS
Doxycycline 100mg twice daily for 14 days
If gonorrhoea is a possibility refer to MSHC treatment
guideline on gonorrhoea.
If it is most likely due to UTI treatment should be:
Ciprofloxacin 500mg twice daily for 10 days
Review at 48 hours and if there is no improvement
the diagnosis should be re-evaluated or admission
considered.
If symptoms of sepsis or systemic symptoms are present
admission to hospital for rest and intravenous antibiotic
treatment should be considered.

All partners of men with epididymo-orchitis not secondary
to a UTI should be tested and managed accordingly.