Epididymo-orchitis

Epididymo-orchitis is inflammation of the epididymis (the tube behind the testicle) and often the testicle itself, usually caused by infection. It causes testicular pain and swelling and, while less urgent than testicular torsion, still requires prompt assessment to distinguish between the two.

• Gradual onset of pain and swelling in one testicle, usually developing over a day or two (unlike the sudden onset typical of torsion)
• Redness and warmth of the scrotal skin on the affected side
• Fever in some cases
• Pain or burning during urination, or urethral discharge, particularly when caused by a sexually transmitted infection
• Relief of pain when the testicle is gently lifted is a feature that can help distinguish this from torsion, though clinical assessment is still needed to be certain

• In younger, sexually active men, most often caused by a sexually transmitted infection, particularly chlamydia or gonorrhoea.
• In older men or boys, more often caused by a urinary tract infection spreading to the epididymis.
• Can occasionally follow viral infections or, less commonly, other causes.

• Diagnosed based on the gradual onset of testicular pain and swelling together with examination findings, and it is essential to distinguish this from testicular torsion, which requires emergency surgery.
• Urine testing can help identify a urinary tract infection as the cause.
• Testing for sexually transmitted infections is recommended in sexually active men, particularly younger patients.
• Doppler ultrasound, where available, can help confirm the diagnosis and rule out torsion in cases where the clinical picture is unclear.

An appropriate antibiotic course is given based on the likely cause — covering sexually transmitted infections in younger, sexually active men, or covering typical urinary pathogens in older men or when a urinary cause is more likely.

Pain relief with an NSAID, along with scrotal support and rest, helps ease symptoms while the antibiotic takes effect.

Sexual partners should be tested and treated if a sexually transmitted infection is identified as the cause.

Any case where torsion cannot be confidently excluded, or where symptoms are severe or sudden in onset, should be referred urgently for further assessment, since torsion is a more time-critical emergency.

• Consistent and correct condom use to reduce the risk of sexually transmitted infections.
• Seek prompt treatment for urinary tract infections.
• Ensure sexual partners are tested and treated if a sexually transmitted infection is identified as the cause.
• Seek prompt medical assessment for any new testicular pain or swelling, since distinguishing this from torsion requires clinical evaluation.