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Epididymo Orchitis

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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


  1. Ewell, George H. "Traumatic epididymo-orchitis." Journal of the American Medical Association 113.12 (1939): 1105-1109.
  2. Trojian, Thomas H., Timothy S. Lishnak, and Diana Heiman. "Epididymitis and orchitis: an overview." Am Fam Physician 79.7 (2009): 583-587.
Created by:
John Kiel on 17 October 2020 00:00:51
Authors:
Last edited:
2 December 2020 15:54:57
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