United Kingdom British association for sexual health and HIV national guideline for the management of epididymo-orchitis, 2020

Abstract

The British Association for Sexual Health and HIV (BASHH) UK guideline for the management of epididymo-orchitis has been updated in 2020. It offers advice on diagnostic tests, treatment and health promotion principles in the effective management of epididymo-orchitis. Empirical treatment should be started in patients with objective swelling and tenderness on testicular examination. First-line empirical treatment for sexually acquired epididymo-orchitis has changed to ceftriaxone 1g intramuscularly and doxycycline. Higher dose of ceftriaxone in line with the BASHH 2018 gonorrhoea guideline ensures effective treatment of strains with reduced susceptibility. Ofloxacin or doxycycline is recommended in patients with epididymo-orchitis probably due to non-gonococcal organisms (e.g. negative microscopy for gram-negative intracellular diplococci or no risk factors for gonorrhoea identified). Where Mycoplasma genitalium is tested and identified, treatment should include an appropriate antibiotic (e.g. moxifloxacin). If enteric pathogens are a likely cause (e.g. older patient, not sexually active, recent instrumentation, men who practice insertive anal intercourse, men with known abnormalities of the urinary tract or a positive urine dipstick for leucocytes and nitrites), ofloxacin and levofloxacin are recommended. A clinical care pathway has been produced to simplify the management of epididymo-orchitis. A patient information leaflet has been developed.

Human Tularemia Epididymo-Orchitis Caused by Francisella tularensis Subspecies holartica, Austria

“…Granulomatous epididymo-orchitis is rare and usually caused by Mycobacterium tuberculosis or Brucella spp. Other rare etiologic agents include fungi, Shistosoma spp., or Orientia tsutsugamushi ( 11 – 13 ). F. tularensis has not been previously reported as a causative microorganism for epididymo-orchitis.…”

Testicular pain

“…Epididymo-orchitis is a clinical syndrome consisting of acute pain, swelling and inflammation of the epididymis and/or the testis (Chirwa et al., 2021). The condition can present as an isolated occurrence of either epididymitis or orchitis or may be a combined event, with over 50% of patients with epididymitis also presenting with orchitis (McConaghy and Panchal, 2016).…”

“…The aetiology of epididymo-orchitis can be either from infectious or non-infectious causes. In pre-pubertal children, the epididymo-orchitis is mainly idiopathic and self-limiting in nature and potentially linked to recent viral illness (Chirwa et al., 2021). Amongst sexually active individuals aged 14 to 35 years, sexually transmitted infections such as Chlamydi a trachomatis or Neisseria gonorrhoea are often causative organisms.…”

“…Amongst sexually active individuals aged 14 to 35 years, sexually transmitted infections such as Chlamydi a trachomatis or Neisseria gonorrhoea are often causative organisms. On the other hand, those aged over 35 years with a low-risk sexual history tend to develop the condition due to enteric organisms such as Escherichia coli which lead to urinary tract infections (Chirwa et al., 2021; McConagahy and Panchal, 2016). Risk factors include men with urinary tract abnormalities, recent urological procedures, positive urine tests and those engaging in insertive anal sex.…”

“…Symptoms typically consist of scrotal pain and/or swelling, fever, dysuria, urethral discharge or parotid swelling (in cases of mumps orchitis) (Chirwa et al., 2021; Jefferies et al., 2015). The management of patients with epididymo-orchitis is guided by the patient’s age group and likely causative organisms, however, it may include antibiotic therapy with agents such as Ofloxacin, Levofloxacin, Co-amoxiclav, Ceftriaxone and Doxycycline (NICE 2023).…”