Epididymitis / epididymo-orchitis

Clinical presentation

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.

STI Atlas (external site)

Investigations

A first void urine should be collected for chlamydia and gonorrhoea 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.

Treatment

Treatment for a sexually transmitted cause should be for at least two weeks.

  • Ceftriaxone 500 mg in 2 mL 1% lignocaine intramuscularly, as a single dose and azithromycin 1g orally as a single dose
  • amoxycillin/clavulanate 500 mg orally, eight-hourly (will also cover many urinary tract infection [UTI] organisms) for 14 days
  • doxycycline 100 mg orally, 12-hourly for 14 days.

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.

Management of partners

Partners should be assessed and offered STI screening and treatment.

Follow up
  • Consider other STIs.
  • Review at end of treatment.
Public health issues

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

Contact tracing is important to prevent reinfection.

Always test for other STIs.