Everything About Epididymo-Orchitis

What Is Epididymo-Orchitis?

As the name suggests, epididymo-orchitis is a medical term to describe the inflammation of the epididymis and testicles. Adults are more likely to experience epididymo-orchitis because of urinary and sexually transmitted infections. The condition is curable, but the patient must complete an entire course of antibiotics. Complications might rarely arise due to this condition. The term epididymo-orchitis can be understood after splitting it into epididymitis and orchitis. The epididymis is a structure present near the testicles, and the inflammation of this structure is known as epididymitis. In contrast, orchitis means the inflammation of the testicles as a whole. The condition is known as epididymo-orchitis because the testicles and the epididymis are located so close to each other that it becomes difficult to interpret whether the testicles or epididymis are inflamed. The condition might occur due to bacterial or viral infections, but the exact cause is still unknown. If the condition is left untreated for a long time, it might trigger pain and affect male fertility.

What Are the Causes of Epididymo-Orchitis?

Epididymo-orchitis might affect males at any age, and some might experience it before puberty. Studies have reported that vesicoureteral reflux is the most common cause of epididymo-orchitis at a young age. It is a condition in which the urine refluxes back to the bladder instead of flowing outside the body. Sometimes epididymo-orchitis might occur due to a rare condition that causes inflammation of the blood vessels. The causes of epididymo-orchitis are listed below:

• Urine Infections: Escherichia coli is the bacteria that cause urinary tract infections. Sometimes, these bacteria might travel down the vas deferens to cause epididymo-orchitis. It is more commonly seen in males above 35 years of age because, at this age, prostate gland enlargement and blockage of the urinary flow are commonly seen. It is because prostate gland enlargement can block the tube that carries the urine outside the body, known as the urethra.

• Sexually Transmitted Diseases: In young males, sexually transmitted infections are the most common cause of epididymo-orchitis. Chlamydial and gonorrheal infections most commonly affect the epididymis and urethra.

• Mumps Virus: Mumps virus might be one of the causes of epididymo-orchitis and occurs in about one in five cases. The virus enters the testicles through the bloodstream and affects them.

• Prostate or Urethral Surgery: A prostate gland and urethra surgery might provide an easy passage for bacterial entry into the epididymis and testicles.

• Medications: Epididymo-orchitis can occur as a side effect of the medication Amiodarone.

What Are the Signs and Symptoms of Epididymo-Orchitis?

The patient might develop symptoms of epididymo-orchitis within a few days, resulting from infections from other diseases. Sometimes, the patient might experience pain in the scrotum and the back of the testis. The other symptoms associated with epididymo-orchitis are listed below:

1. Dysuria (painful urination).

2. Burning sensation while passing urine.

3. Pain in the groin and penis.

4. Abdominal pain.

5. A strong urge to urinate suddenly.

6. Urinary frequency.

7. Fever and flank pain.

8. Swelling and tenderness of the skin around the scrotum.

Epididymo-Orchitis Empiric Therapy - What Has Been Known So Far?

The guidelines for general recommendations and empiric therapy are based on epidemiology and the appropriate choice of antibiotics. Empirical therapy for epididymo-orchitis must be given soon after diagnosis, and the results of urine culture tests are available. This therapy is especially useful when the patient stays in a remote area, and urgent referral to a local specialist sexual health clinic is not possible. The patient must abstain from sexual intercourse until the infection subsides and the follow-up tests have confirmed that the patient and his partner are free from infections. Several factors determine the choice of an antibiotic regimen, including age, sexual history, insertive anal intercourse, recent instrumentation, catheterization, and urinary tract abnormalities. However, antibiotics can be altered based on antibiotic sensitivity and can also be changed when the results of culture and sensitivity are known.

Epididymo-Orchitis Due to Sexually Transmitted Infections:

Epididymo-orchitis is usually associated with sexually transmitted diseases and infections in young men having multiple sexual partners. The risk of these conditions increases if they have urethral discharge. The primary aim of empiric therapy is to eradicate Neisseria and Chlamydia. The drugs administered for this purpose are listed below:

1. Ceftriaxone 250 to 500 mg intramuscularly.

2. Azithromycin 1 g.

3. Azithromycin can be substituted by Doxycycline 100 mg twice daily for seven to 14 days.

According to the revised guidelines, the dose of Ceftriaxone has been increased from 125 to 250 mg to 250 to 500 mg because of the increased resistance of Neisseria to Ceftriaxone. If a sexually transmitted disease, the patient must wear a condom and refrain from engaging in sexual activities for a week.

Epididymo-Orchitis Urologic Microorganisms:

Men above 35 years of age are more likely to experience epididymo-orchitis due to infection with gram-negative enteric organisms. They have shown positive urine dipstick tests concerning leukocytes and nitrites. Fluoroquinolones are the most preferred antibiotics if epididymo-orchitis occurs due to enteric organisms. The recommended antibiotic regimens are listed below:

1. Ciprofloxacin 500 milligram (mg) twice daily for ten to 14 days.

2. Levofloxacin 500 mg once daily for ten days.

3. Ofloxacin 200 mg twice daily for 14 days.

4. Trimethoprim-Sulfamethoxazole (160/800 mg) twice daily for ten days.

5. Amoxicillin-Clavulanic acid 500 mg thrice daily for ten days.

Prepubertal Boys Infected With Enteric Microorganisms:

1. Trimethoprim-Sulfamethoxazole three to six milligram per kilogram (mg/kg) for ten days.

2. Amoxicillin-Clavulanate 15 to 20 mg/kg for ten days.

Supportive Therapy:

1. Have a limited physical activity.

2. Wear scrotal support for scrotal elevation.

3. Apply ice packs.

4. Use anti-inflammatory agents.

5. Analgesics or nerve blocks can be administered.

6. A sitz bath is beneficial.

7. Do not use urethral instruments.

What Are the Complications of Epididymo-Orchitis?

People suffering from epididymo-orchitis usually recover completely and are not likely to experience any complications. However, the following complications usually occur:

• The patient might have persistent pain and swelling in the testicles that affect fertility.

• An abscess might develop due to the accumulation of pus in the scrotum. The abscess might need to be drained surgically.

• Testicles might get affected, and fertility gets reduced due to mumps infection.

• Chronic inflammation or an ongoing infection might persist for a long time.

• The chances of testicular gangrene also increase.

Conclusion:

Epididympo-orchitis is an inflammatory condition in which the epididymis and testicles become inflamed, causing reduced fertility and a decline in sexual activity. Though it is not life-threatening, it might worsen with time, and the patient requires emergency medical care and attention. Several factors increase the risk of epididymo-orchitis, the most common being unprotected sexual intercourse and urologic infections. The diagnosis of this disease is a bit challenging because the symptoms resemble many other testicular conditions. However, the patient should not worry as medical science has advanced, and surgical intervention is required in rare cases. In addition, empiric therapy has emerged as the new line of treatment in the management of epididymo-orchitis. Therefore, the patient must not worry and consult a urologist to know more about empiric therapy for epididymo-orchitis.