Epididymo-orchitis
Epididymo-orchitis is acute inflammation of the epididymis with or without testicular involvement, usually from ascending sexually transmitted or urinary pathogens; the first decision is whether the acute scrotum could be testicular torsion, because imaging and antibiotics must never delay urgent exploration.
Definition
Epididymo-orchitis is acute inflammation of the epididymis with or without extension into the testis. It may be infectious or non-infectious and is most often caused by ascending sexually transmitted or urinary pathogens; mumps is an important viral cause. Testicular torsion is the critical alternative diagnosis.
First principles
The route and risk profile suggest the organism, but age is not a rule
Infection usually spreads locally from the urethra or bladder. Sexually transmitted pathogens, especially chlamydia and gonorrhoea, are common in younger or sexually active men; enteric gram-negative organisms are more likely with urinary symptoms, older age, instrumentation, catheterisation, urinary-tract abnormality or insertive anal intercourse. The groups overlap, so a complete sexual, urinary and procedural history is more useful than age alone.
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