Acute epididymo orchitis - Urinary tract infections

Acute epididymo-orchitis

Definition

Acute primary infection of the epididymis and the testis.

Age

Normally under 40 years.

Sex

Male

Aetiology/pathophysiology

The most common causes are N. gonococcus, Chlamydia trachomatis, E. coli and other gram-negative bacilli. Orchitis is also an important complication of mumps. TB is an important differential. The infection starts in the lower genital tract either as a sexually transmitted infection or as a urinary tract infection. Resolution is usually accompanied by healing and scarring, there may be permanent damage to the tubules risking infertility.

Clinical features

Patients present with a greatly enlarged and very tender testis, the pain usually comes on quickly (30–60 minutes) and is sometimes released by supporting the scrotum. Other causes of a painful scrotal swelling are shown in Table 6.14.

On examination the swelling is confined to one side and the swelling is hot and very tender.

Microscopy

There is extensive infiltration of the seminiferous tubules and interstitium with neutrophils, initial oedema is considerable and there is often patchy haemorrhage.

Complications

Infertility is an important complication.

Investigations

Urine (first catch is best, rather than MSU, under these circumstances) and any urethral discharge should be cultured.

Management

Treatment is with antibiotics, bed rest and scrotal support. In young adults, erythromycin (to cover Chlamydia) is probably best, whereas in older individuals or where there is a good history of UTI, suggested antibiotics are the same as those for UTI, e.g. trimethoprim.