Epididymitis/orchitis
Basics
Description
EpididymitisDescription
- Definition: Inflammation or infection of the epididymis
- Rare in prepubertal boys
- Pathogenesis:
- Initial stages:
- Cellular inflammation begins in vas deferens, descends to epididymis
- Acute phase:
- Epididymis is swollen and indurated in upper and lower poles
- Spermatic cord thickened
- Testis may become edematous owing to passive congestion or inflammation
- Resolution:
- May be complete without sequelae
- Peritubular fibrosis may develop, occluding ductules
- Initial stages:
- Complications:
- 2/3 of men have atrophy due to partial vascular thrombosis of testicular artery
- Abscess and infarction rare (5%)
- Incidence of infertility with unilateral epididymitis unknown:
- 50% with bilateral epididymitis
Orchitis
- Definition: Inflammation or infection of the testicle:
- Usually from direct extension of the same process within the epididymis
- Isolated testicular infection is rare:
- Can result from hematogenous spread of bacteria or following mumps infection
- Categories:
- Pyogenic bacterial orchitis secondary to bacterial involvement of epididymis
- Viral orchitis:
- Most commonly due to mumps
- Rare in prepubertal boys; occurs in 20–30% of postpubertal boys with mumps
- Occurs 4–6 d after parotitis but can occur without parotitis
- Unilateral in 70% of patients
- Usually resolution in 6–10 d
- 30–50% of testes involved have residual atrophy; rarely affects fertility
- Granulomatous orchitis:
- Syphilis
- Mycobacterium and fungal diseases
- Usually occurs in immunocompromised host
Etiology
EpididymitisEtiology
- Children:
- Most common in children <1 yr or between the ages of 12–15 yr
- Etiology identified in only 25% of prepubertal boys
- Coliform or pseudomonal UTI
- Sexually transmitted diseases rare in prepubertal males
- Associated with predisposing abnormalities of lower urinary tract
- Young men, age <35 yr:
- Usually sexually transmitted
- Chlamydia trachomatis (28–88%) with severe inflammation with minimal destruction
- Neisseria gonorrhoeae (3–28%)
- Coliform bacteria (7–24%):
- Highly destructive with tendency for abscess
- Coliform bacteria more common in insertive partners in anal intercourse
- Ureaplasma urealyticum (sole organism in only 6% of cases)
- Older men, age >35 yr:
- Commonly associated with underlying urologic pathology (benign prostatic hypertrophy, prostate cancer, strictures)
- May have acute or chronic bacterial prostatitis
- Coliform bacteria more common (23–67%), especially after instrumentation
- C. trachomatis (8–80%)
- Klebsiella and Pseudomonas species
- N. gonorrhoeae (15%)
- Gram-positive cocci
- Drug related:
- Amiodarone-induced epididymitis:
- Usually with amiodarone levels > therapeutic levels
- Amiodarone-induced epididymitis:
- Granulomatous:
- Etiology maybe related to mycobacterial, syphilis, or fungal infections:
- Mycobacterium tuberculosis is the most common cause of granulomatous disease affecting the epididymis
- Suspect in HIV patients
- Urine cultures often negative for M. tuberculosis
- Etiology maybe related to mycobacterial, syphilis, or fungal infections:
- Vasculitis:
- Polyarteritis nodosa
- Behçet disease
- Henoch–Schönlein purpura
Orchitis
- Pyogenic bacterial orchitis:
- Escherichia coli
- Klebsiella pneumoniae
- Pseudomonas aeruginosa
- Staphylococci
- Streptococci
- Viral orchitis:
- Mumps:
- 20% may develop epididymo-orchitis
- Rarely associated with live-attenuated mumps vaccine
- Coxsackie A and lymphocytic choriomeningitis virus
- Granulomatous orchitis: Syphilis, mycobacterial and fungal diseases:
- Suspect in HIV patients
- Fungal orchitis:
- Blastomycosis in endemic regions
- Invasive candidal infections in immunosuppressed hosts
- Post-traumatic orchitis: Inflammation
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Citation
Schaider, Jeffrey J., et al., editors. "Epididymitis/orchitis." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307739/all/Epididymitis_orchitis.
Epididymitis/orchitis. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307739/all/Epididymitis_orchitis. Accessed October 15, 2024.
Epididymitis/orchitis. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307739/all/Epididymitis_orchitis
Epididymitis/orchitis [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 October 15]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307739/all/Epididymitis_orchitis.
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