What complications can arise from Epididymo-Orchitis ? Is it linked to chlamydia or gonorrhoea?
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What causes Epididymo-Orchitis ?
There are several causes of Epididymo-Orchitis.
•In men under 35 years of age, epididymo-orchitis is most often caused by sexually transmitted pathogens such as Chlamydia trachomatis and Neisseria gonorrhoeae.
•In men over 35 years of age, epididymo-orchitis is most often caused by non-sexually transmitted Gram negative enteric organisms causing urinary tract infections.
Because there is crossover between these groups a qualified medical practitioner/health professional will need to take your complete sexual history.
•Epididymo-orchitis caused by sexually transmitted enteric organisms also occurs in homosexual men who engage in insertive anal intercourse.
What are the symptoms of Epididymo-Orchitis ?
Symptoms of Epididymo-Orchitis include:
•Unilateral testicular pain.
•Urethritis – often with no symptoms.
•Torsion of the spermatic cord (testicular torsion) – the main differential diagnosis – which is a surgical emergency.
Torsion is more likely if:
•The onset of pain is sudden.
•The pain is severe.
•Tests performed during the initial visit show neither the presence of a urethritis nor probable urinary tract infection.
•Torsion is more common in men who are under 20 years of age – predominantly adolescents – but it can occur at any age.
Signs of Epididymo-Orchitis include:
•Tenderness to touch (palpation) on the affected side.
•Noticeable swelling of the highly convoluted duct (epididymis) behind the testicle (testis) along which sperm passes to the vas deferens.
Also, there may be:
•Hydrocoele (the accumulation of a watery substance in the scrotum, surrounding the testes)
•Superficial or patchy reddening (erythema) and/or (excess watery fluid (oedema) of the scrotum on the affected side.
•Raised body temperature or fever (pyrexia).
What are the tests for Epididymo-Orchitis ?
All patients with sexually transmitted epididymo-orchitis should be screened for other sexually transmitted infections.
Tests for Epididymo-Orchitis are:
•A urethral sample (swab) examined microscopically for the diagnosis of urethritis and speculative diagnosis of gonorrhoea.
•Urethral culture for gonorrhoea or a nucleic acid amplification test for gonorrhoea of urethral swab or first-void urine.
•A urine test for C trachomatis or urethral swab.
•Microscopy and culture of mid-stream urine (MSU) for bacteria.
If it can be arranged without delay, colour Doppler ultrasound is useful to help differentiate between Epididymo-Orchitis and torsion of the spermatic cord.
You should be given a detailed explanation of your condition with particular emphasis on the long-term implications for your health and your partner(s). This should be reinforced by giving you clear and accurate written information.
•You will be advised to avoid unprotected sexual intercourse until you and any partner(s) have completed treatment and follow-up.
What is the treatment for Epididymo-Orchitis ?
Before culture results are available, and if it is suspected that you have epididymo-orchitis, you may be given a course of antibiotics prior to confirmation. Your age, sexual history, any recent instrumentation or catheterisation and any known urinary tract abnormalities will also be taken into consideration.
•You must complete the full course of any antibiotics prescribed; otherwise your condition may worsen and become resistant to treatment.
General treatment for Epididymo-Orchitis includes:
•Bed rest, scrotal elevation and support.
•Non-steroidal anti-inflammatory drugs may be helpful.
What complications can arise from Epididymo-Orchitis ?
If there is no improvement in your condition after 3 days, then the diagnosis should be reassessed and treatment re-evaluated.
Reassessment is required if signs of swelling and tenderness persist after anti-microbial therapy has been completed – although in some cases, symptoms take longer than this to settle.
•Hospitalisation leading to surgery.
•Inability to father a child where fertility is affected.
If the Epididymo-Orchitis is caused by, or is likely to be caused by, a sexually transmitted pathogen such as N gonorrhoeae or C trachomatis then all sexual contacts must be evaluated.
•You will need to tell your regular – or other partners – that you have the infection and recommend that they are tested as soon as possible.
•All partners will need to be treated to stop the spread of infection and prevent re-infection.
•Your relationship(s) may become strained, if they also test positive.
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