What is New

Under investigations:

Testing a first pass urine for M. genitalium infection is included (previously considered)

Under treatment:

When most probably due to Chlamydia or other non gonococcal sexually transmitted pathogen (eg where gonorrhoea has been ruled out by gram stain and no risk factors for gonorrhoea identified) ofloxacin has been removed as an alternative first line and is now 2^nd line.

Advice on the use of fluoroquinolones antibiotics has been updated.

Introduction

Acute epididymo-orchitis is a clinical syndrome consisting of pain, swelling and inflammation of the epididymis +/- testes. The most common route of infection is local extension and is mainly due to infections spreading from the urethra (sexually transmitted pathogens) or the bladder (urinary pathogens).

Caution: Exclude torsion by careful clinical examination, especially if sudden onset, young (less than 20yrs usually, but can occur at any age); seek urgent urology opinion.
This is a surgical emergency – salvage of affected testis under 6 hours offers best outcome.