Epididymitis / epididymo-orchitis

Epididymo-orchitis is a condition that presents with pain in the scrotum, often accompanied by swelling. It needs to be differentiated from torsion of the testis by scrotal ultrasound scan. It may be associated with a urethral discharge, dysuria and frequency.

Causative organisms are either from the urinary tract or are sexually transmitted. For patients aged under 35 years, consider treatment for STIs. For patients over 35 years, consider examining for urine pathogens.

In men who practice insertive anal sex, enteric pathogens, e.g. Escherichia coli and Proteus species should be considered. For patients over 35 years, consider examining for urine pathogens.

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A first void urine should be collected for chlamydia, gonorrhoeaand and M. genitalium NAAT, and a mid-stream urine should be sent for routine bacterial culture.

Ultrasound scan may be necessary to rule out torsion of the testis.

• Ceftriaxone 500 mg in 2 mL 1% lignocaine, given by intramuscular injection, as a single dose

PLUS

• Doxycycline 100 mg (orally), starting the next day, twice daily for 14 days.

OR

• Azithromycin 1g (orally) as a single dose, stat, and repeated after 1 week

This regime can be amended once the causative organisms have been identified.

The patient may require admission for pain relief, and scrotal support is often useful. Complete resolution of the swelling may take several weeks, but a substantial reduction of swelling should occur within 4-5 days.

Partners should be assessed and offered STI screening and treatment.

• Consider other STIs.
• Review at end of treatment.

This is not a notifiable disease unless a notifiable infection is found.

Contact tracing is important to prevent reinfection.

Always test for other STIs.