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Epididymo-orchitis (Clinical presentation (Scrotal swelling …
Epididymo-orchitis
Clinical
presentation
Scrotal swelling
Uni/bilateral
Pain
Erythema
Diagnosis
Examination
Male genital examination
Skin changes (erythema, swelling, ulcers/blisters),
masses (size, site, consistency, tenderness, tethering etc.),
lymphadenopathy
Investigations
Swabs
Urethral (MCS and NAAT for NG/CT)
Bloods
BBV (HIV, HCV, HBV, syphilis)
Bedside
Obs (fever)
Urine
FPU (NG/CT NAAT)
MSU (MCS for UTI)
Imaging
Testical USS (rule out torsion)
History
PC/HPC
Swelling, pain, skin changes, dysuria,
LUTS, trauma, systemic (fever, weight loss etc.)
PMH
Previous STIs and UTIs
Chronic medical conditions
Previous genital/abdo surgery
SxH
Partners (casual/regular, gender, age)
Tyoe of sex (vaginal, anal, oral, receptive/passive)
Contraception (UPSI, barrier)
Partners (last 3m and 12m)
BBV risk (IVDU, paid for sex, abroad, blood products)
DH
Current meds, allergies (abx)
SH
Occupation, living arrangements,
alcohol, smoking, drugs
Epidemiology
STIs in <25y
Gram -ves in >35y or structural UT abnormality
Pathophysiology
Agent
STIs - NG, CT
Gram negatives - E Coli, enterobacterae
Other - mumps, TB
Mechanism
Complication of urethra infection
with proximal spread to epididymis and testes
Management
Conservative
Information, advice, support
Advise avoid SI until completed abx
Contact tracing (last 3m)
Rest, supportive underwear
FU 2wk (symptoms, concordance with tx)
Medical
Analgesia
Indication: pain
E.g. paracetamol, NSAID
Abx
Indication: likely STI/UTI
E.g. doxycycline 14d plus ceftriaxone IM (STI);
local UTI guidelines if suspect UTI e.g. ofloxacin;
if suspect NG, add azithromycin 1g IM stat
MOA: doxy+ceft covers both NG and CT
SEs: GIT upset
Definition
Inflammation of the epididymis
and/or testicles due to infection