Epididymo Orchitis
Other Names
- Epididymo-orchitis
- Epididymitis
- Orchitis
Background
- This page refers to (a) epididmyitis, (b) orchitis, and (c) epididymo-orchitis which can all be seen in male athletes
History
Epidemiology
Pathophysiology
- General
- Epididymitis: inflammation of epididymis
- Orchitis: inflammation of testis
- Epididymo-orchitis: features of both
- Causes
- Typically infectious
- Traumatic cases have been reported in athletes[1]
Epididymitis
- May be confused with testicular torsion
- Sexually active men under 35 years old
- Strongly consider N. gonorrhea, C. trachomatis
- Non-sexually active men over 35 or anal intercourse
- Consider E. Coli, P. aeruginosa, Enterobacter, Tuberculosis, Sypilis
- Chemical epididymitis can be seen in patients on amiodarine
Orchitis
- Viral
- Consider Mumps as orchitis is present in 20-30% of cases[2]
- Bacterial
- Typically occurs due to hematogenous spread from epipdidymis, i.e. epididymo-orchitis
- Pathogens: N. gonorrhea, C. trachomatis, E. Coli, Klebsiella, P. aeruginosa
Associated Conditions
Risk Factors
- General risk factors for STI
- Multiple sexual partners
- Unprotected intercourse
- Previous history of STI
Differential Diagnosis
- Epididymo-orchitis
- Testicular Torsion
- Trauma
- Neoplasm
- Idiopathic Scrotal Edema
Clinical Features
- History
- Insidious onset of scrotal and testicular pain
- Pain is typically unilateral
- Absence of trauma
- Dysuria
- Urinary frequency
- Fever may or may not be present
- Recent or current viral illness may suggest mumps orchitis
- Physical Exam
- Tender epididymis, may be thickened
- Tender testicle
- Scrotal erythema, edema
- Inguinal lymphadenopathy
- Special Tests
- Cremasteric Reflex: intact
- Prehn Sign: relief of pain with elevation of testicle
Evaluation
Laboratory
- Urinalysis
- 50% of cases will show pyuria
- Bacteriuria
- Leukocyte esterase, nitrite will also suggest infection
- Urine Culture
- Urine GC/chlamydia
Ultrasound
- Strongly consider in cases in which testicular torsion is a concern
- Orchitis findings
- Inflammation
- Epididymitis
- Exclude torsion
Classification
- Not applicable
Management
Prognosis
- The majority of cases will resolve with appropriate treatment
Nonoperative
- General
- Scrotal Elevation
- Analgesia
- Can generally be treated outpatient
- Consider inpatient management if systemically ill
Antibiotics
- For acute epididymitis/orchitis likely caused by STI
- Ceftriaxone 250 mg IM in a single dose PLUS
- Doxycycline 100 mg orally twice a day for 10-14 days
- For acute epididymitis/orchitis most likely caused by STI and enteric organisms (MSM)
- Ceftriaxone 250 mg IM in a single dose PLUS
- Levofloxacin 500 mg orally once a day for 10-14 days OR Ofloxacin 300 mg orally twice a day for 10-14 days
- For acute epididymitis/orchitis most likely caused by enteric organisms
- Levofloxacin 500 mg orally once daily for 10-14 days OR
- Ofloxacin 300 mg orally twice a day for 10-14 days
- Treat sexual partner if possible
Rehab and Return to Play
Rehabilitation
- Not applicable
Return to Play
- Athlete can usually RTP without restriction unless systemically ill
Complications
- Infertility
- Infect partner
- Disseminated or systemic illness
See Also
References
Created by:
John Kiel on 17 October 2020 00:00:51
Authors:
Last edited:
2 December 2020 15:54:57
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