Inflammation of the epididymis (epididymitis) usually manifests itself by acute onset of unilateral testicular pain and swelling, often with tenderness of the epididymis and was deferens and occasionally with erythema and oedema of the overlying skin. In men under 35 years of age this is more frequently due to sexually transmitted organisms than in those over 35 years of age. When the epididymitis is accompanied by urethral discharge, it should be presumed to be of sexually transmitted origin, commonly gonococcal and/or chlamydial in nature. The adjacent testis is often also inflamed (orchitis), giving rise to epididymo-orchitis.

In older men, where there may have been no risk of a sexually transmitted infection other general infections may be responsible, for example, Escherichia coli, Klebsiella spp. or Pseudomonas aeruginosa. A tuberculous orchitis, generally accompanied by an epididymitis, is always secondary to lesions elsewhere, especially in the lungs or bones. In brucellosis, usually due to Brucella melitensis or Brucella abortus, an orchitis is usually clinically more evident than an epididymitis. In pre-pubertal children the usual aetiology is coliform, pseudomonas infection or mumps virus. Mumps epididymo-orchitis is usually noted within a week of parotid enlargement.

It is important to consider other non-infectious causes of scrotal swelling, such as trauma, testicular torsion and tumour. Testicular torsion, which should be suspected when onset of scrotal pain is sudden, is a surgical emergency that needs urgent referral.

If not effectively treated, STI-related epididymitis may lead to infertility.

Recommended syndromic treatment

• therapy for uncomplicated gonorrhoea (for details see section 3.1)

PLUS

• therapy for chlamydia (for details see section 3.2)

AT A GLANCE

Scrotal Swelling

For details, see section 3.1 and 3.2

Adjuncts to therapy

Bed rest and scrotal support until local inflammation and fever subside.

FIGURE 5. SCROTAL SWELLING