Epididymo-orchitis

Epididymo-orchitis in heterosexual men What is epidiymo-orchitis?

Pain and swelling of the scrotum (ball bag) effecting the epididymis (epididymitis), the testicles (orchitis) or both (epididymo-orchitis). In young men under the age of 35 years it is usually caused by a sexually transmitted infection e.g. chlamydia or gonorrhoea. In older men over the age of 35 years it is usually caused by a non sexually transmitted infection causing urine infections. Prompt medical assessment is needed to rule out the possibility of testicular torsion which can lead to testicular atrophy. If you have epididymo-orchitis we recommend that you should have a full STI screen including an HIV test. Epidiymo-orchitis is easily treated with antibiotics and rest.

How common is epididymo-orchitis?

It occurs most commonly in young men aged 19- 40 years.

How do you catch epididymo-orchitis?

In young men under the age of 35 years the most common cause is a sexually transmitted infection such as chlamydia or gonorrhoea. In older men over the age of 35 years the most common cause is a urine infection - but it may also be caused by a sexually transmitted infection. It may also be caused by bacteria caught during insertive anal intercourse. Rarely epididymo-orchitis may be caused by other infections such as mumps or tuberculosis.

What would I notice if I had epididymo-orchitis?

A rapid onset of pain and swelling in one of your testicles. Some men may also notice a discharge from the tip of the penis and/or pain on passing urine. Occasionally you may feel generally unwell with a fever.

How do I get tested for epididymo-orchitis?

Epididymo-orchitis is diagnosed by a medical assessment, STI screen and urine test. It will be treated immediately at your first visit to the clinic. If there is any concern about a possible torsion of the testicles you will be referred immediately to the Accident & Emergency Department at Kingston Hospital for further assessment and scanning.

How is epididymo-orchitis treated?

Epididymo-orchitis is treated with a mixture of antibiotics to cover the most likely infections. At the Wolverton you will usually be given: CEFTRIAXONE 250mg as a single injection

FOLLOWED BY

DOXYCYCLINE 100mg capsule twice daily for 2 weeks You will be advised to rest, wear a scrotal support and take regular painkillers such as ibuprofen. You will be reviewed again routinely in 2 weeks after completing your antibiotics. If your symptoms have not started to improve within 3 days you should attend the Wolverton again for an early review. Testicular pain and swelling frequently takes many weeks or months to completely settle following treatment.

What about my partner?

Epididymo-orchitis is usually caused by a sexually transmitted infection so it is important that all current female partners are have a full STI screen and are treated with antibiotics too. Sometimes ex partners will need to be tested too you will be advised about this. Make sure that both you and your partner complete your courses of antibiotics before having sex again. For men where the cause has been confirmed as a urine infection, treatment of partners is not required.

What happens if my epididymo-orchitis is left untreated?

The testicular pain and swelling will last much longer. Untreated infection is more likely to lead to complications such as

o o o

chronic testicular pain an abscess rarely testicular atrophy and loss of fertility

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What is torsion? Torsion of the testicle is the most common pediatric urologic emergency. Torsion means that the testicle (testis) itself has been twisted or torsed. The twisting or torsion blocks the blood vessels, which supply the testicle with oxygen and other nutrients. When torsion has occurred and is unrelieved the testicle can die. Why does torsion of the testicle occur? In the fetus the testicle develops within the abdomen and migrates down into the scrotum, trailing its blood supply behind it like a leash. In the scrotum the testicle resides within a smooth sack called the tunica vaginalis. The testicle can spin and move about within the sack. As males grow and age the testicle develops connections with the sack making it harder for the testicle to spin or twist. This is why torsion is usually seen in younger men, adolescents, and children.

Normal testicle with normal blood supply What are symptoms of torsion?

Torsed testicle with twisted blood supply

Sudden scrotal pain is the most common symptom. The pain is usually on one side, but it can spread and be felt in the groin, abdomen, and flank. Some patients may have nausea and vomiting or difficulty urinating. The pain can come during activity, such as sports, or after minor accidents. It can come on at rest or even during sleep. Children, particularly teenage boys, are often reluctant to report testicular or scrotal pain. Hours and sometimes days can pass before they see a physician. The diagnosis of torsion can be difficult to make. Other illnesses can appear like torsion, but because torsion, if left untreated, will lead to the loss of the testicle, any acute scrotal pain is treated as torsion until proven otherwise. How is torsion treated?

When testicles have been torsed they can sustain injury. The key factor is the length of time that the blood supply is occluded. Torsion relieved within six hours or less usually results in no lasting effects, but after six hours there is an increasing risk of damage (decreased sperm production and fertility) or death of the testicle. The only treatment of testicular torsion is immediate detorsion and fixation of the testicle to the scrotal wall. The child is put under general anesthesia and a small incision is made through the scrotum. If the testicle has already died it is removed. If the testicle is twisted, it is untwisted and sewn to the scrotal wall to prevent any further twisting. When torsion is found on one side the other testicle is also sewn to the scrotal wall because experience has shown that if one testicle can twist the other one can as well.

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Testicular torsion. "Torsion" means twisting -- and for a testicle, that's not a good thing. When testicular torsion occurs, the twisting kinks" -- like a garden hose -- and blocks the blood vessels to one testicle. Certain men have a developmental problem that makes them susceptible to testicular torsion. Although testicular torsion is rare, it is an emergency. Sudden testicular pain demands an immediate trip to the emergency room. If treatment is delayed, the testicle can die. Testicular torsion is a true medical emergency. If caught in time, the affected testicle can be saved. Emergency surgery is usually required to "untwist" the testicle and to prevent it from happening again. Sometimes the other side is fixed as well.

Epididymitis. The epididymis is a long, coiled tube that sits alongside the testicle. Its job is to store sperm while they mature. Epididymitis occurs when the epididymis become inflamed or infected. Sometimes, this is a sexually transmitted infection. More often, epididymitis comes from injury, a buildup of pressure such as after a vasectomy, or from urine backwashing into the tubules during heavy lifting or straining. Epididymitis can cause symptoms ranging from mild irritation to severe testicle pain and swelling and fever. Epididymitisis usually treated successfully with antibiotics and anti-inflammatory drugs. Bed rest, pain medications, using an athletic supporter and ice packs on the scrotum may help more severe cases. The pain can resolve very slowly, sometimes taking weeks or months.

Hydrocele. Hydrocele refers to a fluid collection surrounding the testicle and is usually benign. But if it is large enough, it can cause pain or pressure. Though men can develop a hydrocele after injury, the majority of men with hydroceles have no obvious trauma or known cause.

If a hydrocele is very large or causing pain, surgery can usually correct it. Injecting a special material through the scrotal wall can sometimes fix hydroceles without surgery.

Treatment and Home Remedies for Hydrocele

Underlying toxicity that is the root cause should be eliminated. Adopt exclusive fruit 3-meal diet for 10 days. Unsweetened lemon water or plain water can be taken. Use warm water enema. After that follow a diet Breakfast Glass of milk, grated raw carrot, fresh fruit, prunes or dried fruits. Lunch Steamed vegetables with a scrambled or poached egg, baked apple or stewed fruit. Dinner Raw vegetable salad, prunes or dried fruits, whole wheat bread and butter

Natural Water Treatment of Hydrocele

Cold hip baths for 10 minutes each, in the morning and evening are valuable. Hot Epsom salt bath once or twice a week is recommended. Fresh air, out-door exercise, sunbathing should be undertaken. Wearing a suspensor bandage is often useful. And general health should be built to the highest level.