What is acute Epididymo-Orchitis?

It is an acute inflammation of the epididymis (inflammation of the tube attached to the upper part of testes) and the testes. Patients always present with unilateral painful scrotum and swelling.

What are the causes of Epididymo-Orchitis?

It can be caused by sexually transmitted diseases like Gonorrhoea and Chlamydia Trachomatis. It can also be caused by non-sexually transmitted bacteria like E Coli, M. Tuberculosis or Pseudomonas Aeruginosa. Other non-infectious causes include trauma and testicular torsion. Testicular torsion occurs in younger males with sudden onset testicular pain without any urinary disturbances.

It is highly suspicious to be sexually transmitted if it is a sexually active male with multiple partners who has symptoms and signs of urethritis (inflammation of the urethra).

Diagnostic tests for epididymo-orchitis

There are a couple of tests that can be conducted to deduce the cause of epididymo-orchitis episode. These include:

1.NAAT (nucleic acid-based amplification tests): the first void urine in the morning and smear of sample taken from the urethra should be tested for chlamydia trachomatis and Neisseria Gonorrhoea.

2.Gram Stained smear and Culture: A sample taken from the urethra should be sent for gram stained smear and culture for Neisseria Gonorrhoea.

3.Mid-stream Urine: A sample of middle stream urine should be sent for microscopic examination and culture for bacteria pathogens.

Treatment of epididymo-orchitis

After doing the diagnostic tests and identifying the causative bacteria pathogens, patients are treated appropriately with the correct antibiotics. Bed rest and scrotal elevation may relieve some pain. Pain killers like non-steroidal anti-inflammatory drugs will help relief the pain and inflammation.

If the infection is caused by sexually-transmitted pathogens, they should be treated with an intra-muscular injection of 500mg ceftriaxone for 1-3 days together with oral doxycycline 100 mg twice daily for 10-14days. An alternative oral antibiotic is oral erythromycin 500 mg 4 times daily for 10-14 days.

For infection not caused by sexually – transmitted pathogens, they can be treated with oral ciprofloxacin 500 mg twice daily for 10-14 days or oral ofloxacin 200 mg twice daily for 10-14 days. 

Management of sexual contacts

Sexual partners of patients who have sexually infected epididymo-orchitis within the prior 2 months should be examined by a doctor and tested for sexually transmitted diseases. If positive they should be treated. 

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