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A questionnaire survey and case notes audit reviewing management of epididymo-orchitis (E-O) by 34 Genitourinary Medicine (GUM) clinics located in the North Thames was undertaken. Twenty-two clinics (65%) returned completed questionnaires and audited a total of 83 newly diagnosed cases. All participating clinics offer microscopy of urethral smears and screening for Neisseria gonorrhoeae and Chlamydia trachomatis to all patients, regardless of age. However, greater numbers of clinics would offer routine microbiology of mid-stream urine (MSU) samples (20/22, 91% versus 16/22, 73%) and scrotal ultrasound (5/22, 23% versus 1/22, 5%) to patients aged over 35, compared with men under 35. Half of the cases audited were due either to sexually transmitted infections (STIs) (41/83, 49%), or associated with ascending urinary tract infections (4/83, 5%). No obvious infectious cause was identified for 38/83 cases (46%). Reported management was appropriate for the causative conditions diagnosed and accorded with the UK National Guidelines for this and related conditions.
Int J STD AIDS 2001 May
PMID:Management of epididymo-orchitis in Genitourinary Medicine clinics in the United Kingdom's North Thames region 2000. 1136 10

Acute epididymo-orchitis is a common cause of 'acute scrotum' in adolescence and young adults, and the common causative pathogens are Chlamydia trachomatis and Neisseria gonorrhoeae. This is a rare case of acute epididymo-orchitis due to Pseudomonas aeruginosa in a pubertal boy with a history of 'ano-receptive' intercourse. On Medline search there are no reports of pseudomonas orchitis in this age group.
Int J STD AIDS 2004 Oct
PMID:Pseudomonas orchitis in puberty. 1547 10

Epididymo-orchitis among men younger than 35 years is mainly caused by chlamydial infection. National guidelines for the management of this condition have been published. The aim of this study was to audit the management of epididymo-orchitis in a major teaching hospital. To this end we performed a retrospective study of patients with epididymo-orchitis admitted to the Department of Urology in the Western General Hospital, Edinburgh between 1998 and 2003. Case-notes of 108 cases of epididymo-orchitis were reviewed. The diagnosis was established by ultrasound in 94% of cases. Patients were not tested routinely for chlamydial infection and the majority of men younger than 35 years were treated inappropriately with ciprofloxacin. The management of patients younger than 35 years was not in accordance with the recommendations of national guidelines. Chlamydia trachomatis is sexually transmissible and is not responsive to ciprofloxacin. As a result of this audit, each patient will be tested for chlamydial infection and men younger than 35 years will be treated with ofloxacin. Sexual partners of patients with chlamydial infection will be treated in the department of genitourinary medicine.
Int J STD AIDS 2005 May
PMID:Audit on the management of epididymo-orchitis by the Department of Urology in Edinburgh. 1594 72

Mumps epididymo-orchitis has not been recorded as a cause of testicular symptoms without systemic features (including parotitis). The aim of the present study was to assess if we were missing cases in the genitourinary clinic during a previous outbreak of mumps in the community. During a prospective pilot study from November 2005 to February 2006, all patients presenting with symptoms or signs of epididymo-orchitis were studied. These patients were assessed for previous exposure to mumps virus or vaccine, and any current evidence of systemic illness. All patients included had a full sexual health screen (loop test, chlamydia polymerase chain reaction [PCR], gonorrhoea culture, HIV and Venereal Disease Research Laboratory [test]/Treponema pallidum particle agglutination assay), urinary tract infection excluded by urinalysis and mid-stream specimen of urine (MSSU) and mumps serology (Immunoglobulin M [IgM] and Immunoglobulin G [IgG]) performed. Twenty-three patients met inclusion criteria. Their ages ranged from 16 to 50 years, average 30.8 years. All had symptoms of these, 18 had testicular pain, eight swelling, (four had both pain and swelling) and three also had dysuria. On examination, 12 had tenderness, seven swelling, (two both tenderness and swelling) and six had no signs. Seventeen denied history of mumps, one patient had a record of vaccination and five described fever. None had parotid swelling. Three patients were chlamydia PCR positive, two had candida cultured, three had non-specific urethritis (>10 polymorphonuclear leucocyte/high powered field) and 13 had negative sexually transmitted infection screen (one known HIV-positive). Three had positive IgM mumps serology and two were IgG-positive. It is important to include mumps in the differential of epididymo-orchitis and to be aware of outbreaks in the community that may present with genital symptoms, as the management and partner notification will be different.
Int J STD AIDS 2007 May
PMID:Are we missing mumps epididymo-orchitis? 1752 97

We report two cases who attended the genitourinary medicine clinic for the treatment of epididymo-orchitis. They did not respond to treatment and subsequent ultrasound sonography (USS) of testis confirmed microlithiasis and excluded any inflammatory process or carcinoma in situ. Because of its association with testicular cancer, these patients should be followed up by USS at least once a year on a long-term basis after diagnosis. Patients should be encouraged for testicular self-examination.
Int J STD AIDS 2008 Apr
PMID:Microcalcification of testis presenting as epididymo-orchitis. 1848 50

We report a case of acute epididymo-orchitis due to early infectious syphilis, mimicking as testicular malignancy in an undiagnosed HIV-positive individual. He presented with a mass on his testicle and simultaneously had serology consistent with early syphilis. It could not be distinguished from a malignancy, which necessitated urgent orchidectomy. Histology showed endarteritis but no evidence of gummatous involvement. Although treponemes were not detected by staining, the diagnosis was confirmed by the first reported use of Treponema pallidum polymerase chain reaction in a testicular specimen in the UK.
Int J STD AIDS 2009 Jan
PMID:Acute syphilitic interstitial orchitis mimicking testicular malignancy in an HIV-1 infected man diagnosed by Treponema pallidum polymerase chain reaction. 1910

The BASHH UK guideline for the management of epididymo-orchitis has been updated in 2010. Consideration should be made of the changing potential aetiologies of epididymo-orchitis - mumps in non-immune individuals and tuberculosis in the immunocompromised and men from countries of high prevalence. The treatment of sexually acquired epididymo-orchitis has changed given the high levels of quinolone-resistant gonorrhoea such that ceftriaxone and doxycycline are recommended in those at high risk of gonorrhoea and doxycycline or ofloxacin in those patients where gonorrhoea is considered unlikely (negative microscopy for Gram-negative intracellular diplococci and no risk factors for gonorrhoea identified). A clinical care pathway has also been produced to simplify the management of epididymo-orchitis.
Int J STD AIDS 2011 Jul
PMID:BASHH UK guideline for the management of epididymo-orchitis, 2010. 2172 51

A 47-year-old man presented to his general practitioner (GP) with painful swelling of his right testis. He was diagnosed with epididymo-orchitis and a two-week course of erythromycin 500 mg four times daily was prescribed by his GP. Despite initial improvement, his symptoms persisted and he was referred to the local urology department. His sexual history revealed one lifetime sexual contact. A midstream urine sample grew non-lactose fermenting coliforms sensitive to ciprofloxacin and a two-week course of ciprofloxacin 500 mg two times daily was prescribed. Despite clinical improvement, a persistent suspicious abnormality on the ultrasound scan of his right testis prompted a right radical inguinal orchidectomy to exclude malignancy. Further diagnostic tests including histopathology excluded malignancy but confirmed tertiary syphilis. A comprehensive literature search revealed only 11 confirmed cases in the past 59 years.
Int J STD AIDS 2011 Sep
PMID:The gumma and the gonad: syphilitic orchitis, a rare presentation of testicular swelling. 2189 May 56

Worldwide, it is estimated that 14.8% of all new tuberculosis cases in adults are attributable to HIV infection. Genitourinary tuberculosis is a known complication and is considered to be a severe form of extrapulmonary tuberculosis. Isolated tuberculous epididymo-orchitis is rare. We report a Caucasian HIV-positive heterosexual male with a clinical diagnosis of testicular tumour for which he underwent a right orchidectomy. Tuberculous epididymo-orchitis was confirmed by histology. In this case, all Immune Reconstitution Inflammatory Syndrome (IRIS) criteria were met. We want to convey the message that in HIV-positive patients presenting with testicular swelling, an infective aetiology should be considered. This will increase the possibility of early diagnosis and proper management.
Int J STD AIDS 2017 01
PMID:Unmasking immune reconstitution inflammatory syndrome: a report of tuberculous epididymo-orchitis mimicking a testicular tumour in a Caucasian AIDS patient. 2722 88

The aetiology of epididymo-orchitis is largely related to a patient's age with sexually transmitted pathogens being the common aetiological agents in those below 35 years of age. In individuals aged over 35, uropathogens represent the commonest cause. National guidelines exist for the appropriate management of this condition and its varying aetiology. We aimed to assess the management of epididymo-orchitis in our clinic with reference to the British Association for Sexual Health and HIV national guidelines. We describe the demographics, investigations, treatment and outcomes of patients presenting with epididymo-orchitis to the John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital.
Int J STD AIDS 2017 09
PMID:Retrospective review of the management of epididymo-orchitis in a London-based level 3 sexual health clinic: an audit of clinical practice. 2820 51


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