🍒 Epididymo-orchitis: Scrotal Pain & SwellingDemystified! 🚦

Let’s get you ready to smash those MSRA questions.

Here’s everythingyou need—clear, concise, and easy to remember.

💡 What is Epididymo-orchitis?

• Inflammation of epididymis and testis
• Usually infectious (bacterial most common)
• Key symptoms: scrotal pain, swelling, redness (usually one side)

🦠 Common Causes

• STIs:
   Chlamydia trachomatis & Neisseria gonorrhoeae (esp. <35 yrs)
• UTIs (older men, structural urinary issues)
• Mumps (post-pubertal males)
• TB (rare, but exam favourite)
• Iatrogenic: after urological procedures/catheters
• Drugs: Amiodarone
• Immunocompromised? Higher risk!

⚡️ Risk Factors

• Risky sexual behaviour (unprotected sex)
• Previous STI or UTI
• Urinary tract abnormalities
• Recent instrumentation/catheter
• Age: 15–35 (STI) & >60 (UTI)

🧬 Pathophysiology

• Ascending infection (urethra → epididymis → testis)
• Direct invasion → inflammation, pain, swelling
• Less commonly: blood-borne or viral spread

🔍 Differential Diagnosis (Don’t Miss!)

• Testicular torsion (sudden, severe pain—surgical emergency!)
• Trauma, tumour, abscess, hydrocele, varicocele

Mnemonic:

Torsion, Trauma,Tumour – must rule out!

📊 Epidemiology

• ~1 in 1000 men/year (UK)
• Bimodal:
   15–35 (STI), >60 (UTI/prostate)
• Mumps orchitis: up to 40% of post-pubertal mumps cases!

🤒 Clinical Features

• Gradual onset pain & swelling (vs torsion = sudden!)
• Tender, swollen epididymis/testis (often lower pole, unilateral)
• Red, hot scrotum
• +/- penile discharge (STI), dysuria, fever
• Hydrocele, scrotal oedema

🧪 Investigations

• Urine dip/culture
• NAAT for Chlamydia/Gonorrhoea
• Urethral swab (STI suspicion)
• Scrotal ultrasound (+Doppler: rule out torsion!)
• FBC, CRP, U&E
• Consider mumps, TB, HIV tests as indicated

💊 Management

• Antibiotics:
   - STI (young men): IM ceftriaxone + doxycycline
   - UTI (older men): Ciprofloxacin/ofloxacin (based on culture)
• Pain relief: Paracetamol/NSAIDs
• Scrotal support & rest
• Cold packs, elevation
• Partner notification/treatment (if STI)
• Follow-up: Ensure resolution, check for complications

🚩 Complications

• Abscess (may need drainage)
• Chronic pain or swelling
• Testicular atrophy
• Infertility (esp. mumps/TB, severe or delayed cases)
• Sepsis (rare, serious)

🧠 Memory Tip

SCROTAL PAIN mnemonic:

Swelling Causes Red flags (torsion)

Orchitis Tests(urine, US) Antibiotics

Lover/partner notification Pain relief

Atrophy risk Investigations Need for follow-up

📚 MSRA Quick Links

• Revision Notes:
  https://www.passthemsra.com/topic/epididymo-orchitis-revision-notes/
• Flashcards:
  https://www.passthemsra.com/topic/epididymo-orchitis-flashcards/
• Accordion Q&A:
  https://www.passthemsra.com/topic/epididymo-orchitis-accordion-qa-notes/
• Rapid Quiz:
  https://www.passthemsra.com/topic/epididymo-orchitis-rapid-quiz/
• Full Quiz:
  https://www.passthemsra.com/quizzes/epididymo-orchitis/
• Free resources:
  https://www.passthemsra.comhttps://www.freemsra.com

🏁 KEY TAKEAWAYS

• Gradual scrotal pain/swelling? Think epididymo-orchitis!
• Always exclude torsion first
• Treat early, follow up, educate on partner treatment

#MSRA#EpididymoOrchitis #ScrotalPain #STI #UTI #Urology #GPExamPrep #PassTheMSRA#FreeMSRA 🚦🍒💊