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Epididimyorchitis

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epididymitis AND treatment

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CDC epididymitis treatment guidelines 2021 STI

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Epididymo-orchitis is inflammation, usually infection, of the epididymis and testis. Inflammation limited to the epididymis is called epididymitis. - Bailey and Love's Short Practice of Surgery, 28th ed., section “Epididymo-orchitis”

Typical features

  • Gradually worsening, usually one-sided scrotal pain, swelling, warmth and tenderness
  • Fever, burning urination, urinary frequency, urethral discharge, or lower abdominal pain may occur
  • The epididymis is affected first and infection can extend to the testis.

Common causes

  • Sexually active younger men: commonly Chlamydia trachomatis or Neisseria gonorrhoeae
  • Older men, urinary obstruction, catheter/instrumentation: urinary bacteria, often enteric organisms such as E. coli
  • Less commonly: viral orchitis, including mumps, tuberculosis, or other infections.

Diagnosis

A clinician should examine the scrotum and usually perform:
  • Urine analysis and urine culture
  • Urine NAAT testing for chlamydia and gonorrhea where relevant
  • Scrotal Doppler ultrasound if testicular torsion cannot be confidently excluded, or if abscess is suspected.
Testicular torsion must be ruled out urgently. Sudden severe testicular pain, high-riding or abnormally positioned testis, nausea/vomiting, or pain beginning within hours warrants emergency assessment now. Torsion can threaten testicular viability within hours.

Treatment

Treatment depends on the likely organism and local resistance guidance. It generally includes:
  • Prescribed antibiotics
  • Rest, scrotal elevation/support, ice packs
  • Anti-inflammatory pain medication if safe for you
  • Treatment and testing of sexual partners if an STI is suspected
  • Avoid sex until treatment is complete, symptoms have resolved, and partners have been managed.
For suspected STI-associated infection, the CDC epididymitis guidance recommends ceftriaxone plus doxycycline; regimens differ when enteric urinary organisms are likely. Antibiotics should be selected by a clinician rather than self-started.
Seek urgent care if there is severe pain, high fever, vomiting, rapidly increasing swelling/redness, inability to pass urine, or no improvement within 48-72 hours of starting treatment.
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