Epididymo-orchitis is inflammation of the epididymis, and occasionally the testis.
|Scrotal pain and swelling||Usually unilateral. Swelling, induration and tenderness of the epididymis is the most common sign. Consider cancer if swelling is confined to the body of the testis. If very acute onset or severe pain consider torsion and urgent surgical referral.|
|Dysuria or urethral discharge||Urethral symptoms are often absent despite the presence of STIs (if present the patient would have sought treatment earlier).|
|Suprapubic pain, frequency, and nocturia||Suggests urinary pathogen rather than STI.|
|Gonorrhoea||FPU||NAAT. If NAAT test result positive, take swab at relevant site(s) for culture, before treatment.|
|Urinary pathogens||MSU||Microscopy, culture, and sensitivities|
|FPU – First pass urine
NAAT – Nucleic Acid Amplification Test
MSU – Mid-stream urine
If diagnosis remains uncertain and pain is severe, refer for urgent urological review. Torsion can result in the loss of the testis within hours.
Treat sexually active men with epididymo-orchitis presumptively for gonorrhoea and chlamydial infection.
|Principle treatment options|
|Chlamydia/gonorrhoea suspected||Ceftriaxone 500mg in 2mL of 1% lignocaine IMI, stat
Doxycycline 100mg PO, starting the next day, BD for 14 days
Azithromycin 1g PO, stat and repeated 1 week later
See Australasian Contact Tracing Manual - Epididymitis for more information.
Follow up at 4-5 days provides an opportunity to:
Consider testing for other STIs, if not undertaken at first presentation, or retesting post the window period.
For test of cure (TOC) and retesting advice see:
If STI-related, 100% of regular partners are tested and treated.
RCGP Sex, Drugs, HIV and Viral Hepatitis Group British Association for Sexual Health and HIV (BASHH) 2013.