Orchitis & epididymitis
- 2. •Orchitis is an inflammation of the testicles. It can be caused by either bacteria or a virus. •Both testicles may be affected by orchitis at the same time. However, the symptoms are usually in just one testicle. •This kind of testicular inflammation is often associated with the mumps virus. Orchitis
- 3. OTITIS
- 4. SYMPTOMS •PAIN IN THE TESTICLES AND GROIN IS THE PRIMARY SYMPTOM OF ORCHITIS. •TENDERNESS IN THE SCROTUM •PAINFUL URINATION •PAINFUL EJACULATION •A SWOLLEN SCROTUM •BLOOD IN THE SEMEN •ABNORMAL DISCHARGE •AN ENLARGED PROSTATE •SWOLLEN LYMPH NODES IN THE GROIN • FEVER
- 5. Testicular examination reveals the following: • Testicular enlargement • Induration of the testis • Tenderness • Erythematous scrotal skin • Edematous scrotal skin • Enlarged epididymis On rectal examination, there is a soft boggy prostate (prostatitis) • Other findings include parotitis and fever. CLINICAL MANIFESTATIONS
- 6. • Most commonly, mumps causes isolated orchitis. • Other rare viral etiologies include coxsackievirus, infectious mononucleosis,varicella, and echovirus. • Bacterial causes usually spread from an associated epididymitis in sexually active men or men with BPH: – bacteria include Neisseria gonorrhoeae, Chlamydia trachomatis, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus and Streptococcus species. –Bacterial orchitis rarely occurs without an associated epididymitis. CAUSES
- 7. • People who engage in high-risk sexual behavior may be more likely to develop orchitis. High-risk sexual behavior includes: • having sexual intercourse without condoms • having a history of STIs • having a partner who has an STI • Congenital urinary tract abnormalities can also increase risk of orchitis. This means if one is born with structural problems involving bladder or urethra. Risk Factors for Orchitis
- 8. DIAGNOSIS
- 9. Laboratory tests are often not helpful in making the diagnosis of orchitis • Diagnosing mumps orchitis can be comfortably made based on history and physical examination alone. Diagnosing mumps orchitis can be confirmed with serum immunofluorescence antibody testing. • In sexually active males, urethral cultures and gram stain should be obtained forChlamydia trachomatis and N gonorrhoea. • Urinalysis and urine culture should also be obtained. LABORATORY STUDIES
- 10. • Color Doppler ultrasonography has become the imaging test of choice for the evaluation of an acute scrotum. IMAGING STUDIES
- 11. • Because orchitis often presents as acute edema and pain of the testicle, ruling out testicular torsion is critical. A finding of a normal-sized testicle with decreased flow is suggestive of torsion, whereas a finding of an enlarged epididymis with thickening and increased flow is more suggestive of epididymitis/orchitis. ..contd
- 12. • There’s no cure for viral orchitis, but the condition will go away on its own. –Suppurative treatment maybe applied: •Bed rest. •Hot or cold compress. •Scrotal elevation. •Bacterial orchitis is treated with antibiotics, anti- inflammatory medications, and cold packs. TREATMENT
- 14. • Epididymitis is the inflammation of the epididymis. • If the inflammation spreads to the testicle spreads to the scrotum it is called orchiepididymitis. What is it?
- 15. Epididymitis A: Caput or head of the epididymis B: Corpus or body of the epididymis C: Cauda or tail of the epididymis D: Vas deferens E: Testicle
- 16. •Heavy sensation in the testicle area •Painful scrotal swelling •Fever •Chills •Testicle pain gets worse with pressure •Lump in the testicle SYMPTOMS
- 17. •Blood in the semen •Discharge from the urethra •Pain or burning during urination or ejaculation •Discomfort in the lower abdomen or pelvis SYMPTOMS
- 18. • Tenderness and induration occurring first in the epididymal tail and then spreading • Elevation of the affected hemiscrotum • Normal cremasteric reflex • Erythema and mild scrotal cellulitis • Reactive hydrocele (in patients with advanced epididymo-orchitis) • Bacterial prostatitis or seminal vesiculitis (in postpubertal individuals) • With tuberculosis, focal epididymitis, a draining sinus, or beading of the vas deferens. CLINICAL MANIFESTATIONS
- 19. •Sexual intercourse with more than one partner and not using condoms •Being uncircumcised •Recent surgery or a history of structural problems in the urinary tract •Regular use of a urethral catheter RISK FACTORS
- 20. •Among sexually active men aged <35 years –C. trachomatis or N. gonorrhoeae •Men who are the insertive partner during anal intercourse: –Escherichia coli and Pseudomonas spp •Men aged >35 years –Sexually transmitted epididymitis is uncommon –Bacteriuria secondary to obstructive urinary disease is more common CAUSES
- 21. DIAGNOSIS
- 22. • Urinalysis: Pyuria or bacteriuria (50%); urine culture indicated for prepubertal and elderly patients • Complete blood count: Leukocytosis • Gram stain of urethral discharge, if present • Urethral culture, nucleic acid hybridization, and nucleic acid amplification tests to facilitate detection of Neisseria gonorrhoeae and Chlamydia trachomatis • Performance of (or referral for) syphilis and HIV testing in patients with a sexually transmitted etiology • The use of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to differentiate epididymitis from other causes of acute scrotum is under investigation LABORATORY STUDIES
- 23. •Voiding cystourethrogram (VCUG) •Retrograde urethrography •Abdominal/pelvic ultrasonography •Radionuclide scanning and scintigraphy •In tuberculous epididymitis, chest radiography, computed tomography, or excretory urography IMAGING STUDIES
- 24. DOPPLER SONOGRAM
- 25. • Empiric treatment is indicated before laboratory results are available • Goals of treatment of acute epididymitis caused by C. trachomatis or N. gonorrhoeae: –Microbiological cure of infection –Improvement of signs & symptoms –Prevent transmission to others –Reduce potential complications TREATMENT
- 26. • Recommended Regimens: –Ceftriaxone 250mg IM in a single dose PLUS –Doxycycline 100mg PO BID x 10 days For epididymitis most likely caused by enteric organisms: –Levofloxacin 500mg PO once daily x 10 days OR –Ofloxacin 300mg PO BID x 10 days. TREATMENT
- 27. •Practicing safe sex •Treating sexual partners as a contact to epididymitis •Repeat screening for STI ~ 2 months after initial testing for re-infection •Abstain from sex until the individual & sex partners have completed treatment PROPHYLAXIS
- 28. Thank you!