EPIDIDYMO-ORCHITIS: SYMPTOMS, CAUSES, TREATMENT - MEDICINE - 2025

The orquiepididimitis is male urological clinical syndrome characterized by pain and inflammation of the epididymis and testicle. It is considered in the acute phase when the symptoms appear in less than two weeks, and chronic when it exceeds 6 weeks.

The testicle is the male gonad, its shape is ovoid, it is flattened in its transverse axis, bluish-white, smooth and shiny. It has a very lively and characteristic sensitivity, produces sperm and participates in the formation of essential male hormones.

The epididymis is a structure of the male reproductive system that is part of the spermatic pathways, is attached to the back of the testicles and is the collecting and excretory pathway for sperm. It consists of a rounded head, an elongated body and a free tail, culminating in the vas deferens.

As a result of a migration of the testicle in intrauterine development, both the testicle and the epididymis are located within the scrotum (scrotal bags), under the penis and perineum, between both thighs.

The scrotum keeps them about 1 degree below body temperature. So that the spermatogonia can mature and form the mature sperm.

Symptoms of epididymo-orchitis

They usually have a sudden onset, with intense pain that radiates along the spermatic cord and even to the groin. It is accompanied by swelling very sensitive to palpation of the scrotum, edema that makes the skin smooth and without wrinkles, it is indurated and with erythema.

It is usually unilateral, although in some very atypical cases it can be bilateral and does not cause atrophy or sterility in its acute phase.

Dysuria and / or urethral discharge may occur. High fever, chills, nausea and vomiting and in some cases compromise of the general condition of the patient.

Causes

The causes can be classified by age or by etiologic agent.

Prepubescent

The most frequent cause of epididymo-orchitis in prepubertal women is viral infections, although it is not exclusive for this age.

Mumps Myxovirus is the virus that produces mumps (or mumps in some countries). It has a predilection for glandular tissue, therefore, although they initially colonize the salivary glands, if they become complicated or not treated early or adequately, they can colonize the pancreas or testicles and cause epididymo-orchitis.

The inflammation appears 4 - 6 days from the onset of mumps.

Adolescents and adults

The most frequent cause is infectious, many due to sexually transmitted diseases due to Chlamydia trachomatis, Neisseria gonorrhoeae and some others due to bacterial spread, Echerichia coli more commonly, although other gram-positive enterobacteria and cocci can also be found.

The most common causes of bacterial infections can be bladder catheterizations, physical scrotal injuries, recurrent urinary tract infections, among others.

Epididymo-orchitis can occur due to the continuity of inflammatory processes of the epididymis that cause pyogenic bacterial orchitis or due to metastatic seeding of other microorganisms such as brucellosis.

However, not only infectious processes of viral or bacterial origin are the cause of this pathology. Other causes can be hypothermine, decreased immune system, decreased blood flow due to obstruction or due to the use of medications such as amiodarone, although their relationship has not been clearly established.

Diagnosis

For its correct diagnosis, clinical symptoms, epidemiology and paraclinical symptoms are taken into consideration.

Some of the characteristic clinical signs in epididymo-orchitis are:

Positive Prehn's sign

It means that by raising and supporting the scrotum, pain is relieved, in case of exacerbation of pain it is considered a possible testicular torsion.

Cremasteric reflex present

It consists of lightly striking the superomedial region of the thigh, generating a contraction of the cremasteric muscle that moves the testicle to the side of the blow.

Among the paraclinicals are:

• White blood cell count in the blood count.
• CRP + and elevated ESR.
• Scrotal Duplex Doppler Sonography, which detects an increase in blood flow to the affected epididymis and testicular torsion with similar symptoms is ruled out.
• Urethral exudate.
• Urinalysis and Urine culture.

Treatment

Pharmacological treatment depends on the etiology of the infection. Specific antibiotic therapy according to each microorganism:

• Chlamydia trachomatis, Neisseria gonorrhoeae infection: Ceftriaxone 250mg IM single dose + Doxycycline 100mg orally every 12 hours for 10 days.
• In case of Enterobacterial infections: Levofloxacin 500mg orally every 24 hours for 10 days.

As general measures, bed rest for 72 hours, local ice, the use of jockstrap, oral analgesics and antipyretics in case of elevation of body temperature are indicated.

In some cases of very severe pain that does not subside with oral analgesia, lidocaine can be injected into the spermatic cord.

References

1. José H. Pabón. "Enrique Tejera" Hospital City Surgeon. Valencia, Venezuela. Practice Consultation Clinics - Medical. Medbook Medical Editorial. Second Edition (2014). P. 308-309.
2. The Ruiz Liard card. Human anatomy. Editorial Médica Panamericana. 4th Edition. 2nd Volume. Pages 121 - 123.
3. Christina B Ching, MD; Medscape. Epididymitis Treatment and management December 15, 2017. Recovered from: emedicine.medscape.com
4. Orchiepididymitis: causes, signs, symptons and treatment. August 2017. Recovered from: symptomms.com
5. Diagnosis and treatment of Epididymitis, Orchitis and Epididymitis in children and adults. National Health Council. Clinical practice guide. United Mexican States. Recovered from: coescamedcolima.mx