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
- Mumps virus (orchitis)
- Escherichia coli
- Chlamydia
- Gonococcus
- Staphylococcus
- Streptococcus
- Pseudomonas
- 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
- 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 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.