Epididymitis and Orchitis Overview

Age Factors and Pathogens

• Men aged 14 to 35 years are most affected by epididymitis and orchitis.
• Common pathogens in this age group include Chlamydia trachomatis and Neisseria gonorrhoeae.

Physical Findings

• Typical findings include swollen, tender epididymis or testis in normal anatomical position with intact ipsilateral cremasteric reflex.

Prevalence and Causes

• Epididymitis is more common than orchitis.
• The primary cause of intrascrotal inflammation is epididymitis.
• Infections causing epididymitis in the 14-35 age group are predominantly from Neisseria gonorrhoeae and Chlamydia trachomatis.
• For those younger than 14 or older than 35, common urinary tract pathogens like Escherichia coli are typically responsible.

Risk Factors

• Risk factors for all men include:
  • Sexual activity
  • Strenuous physical activity
  • Bicycle or motorcycle riding
  • Prolonged sitting (e.g., during travel or sedentary jobs)
• In men over 35 and prepubertal boys, risk factors include:
  • Recent urinary tract surgery or instrumentation
  • Anatomic abnormalities (e.g., prostatic obstruction in older men, posterior urethral valves, meatal stenosis in boys)

Viral Infections and Orchitis

• Mumps is the most common cause of viral orchitis, which presents with abrupt unilateral scrotal pain and swelling.
• Orchitis associated with mumps generally appears 4 to 7 days after parotitis.

Torsion and Diagnosis

• Torsion of the appendix testis typically occurs in boys aged 7 to 14 years, rarely after age 20.
• Tenderness in the spermatic cord suggests epididymitis.
• A “blue dot” sign presents as bluish discoloration on the scrotal wall, indicative of infarction and necrosis.

Reflexes and Signs

• Cremasteric reflex is elicited by stroking the skin of the upper medial thigh, resulting in ipsilateral testis elevation in normal conditions.
• The cremasteric reflex is present in epididymitis and orchitis but absent in testicular torsion.
• Prehn's sign indicates relief of pain with elevation of the testis, typically seen in epididymitis.

Ultrasound Findings

• A normal testicle showing decreased Doppler wave pulsation suggests torsion.
• An enlarged, thickened epididymis with increased Doppler wave pulsation indicates epididymitis.

Treatment and Follow-up

• Antibacterial medications are unnecessary for viral orchitis; most cases resolve spontaneously within 3 to 10 days.
• Recommended follow-up is 3 to 7 days post-evaluation to check clinical improvement and for testicular mass presence.
• Pain management typically improves within 1 to 3 days, but full resolution of induration may take 2 to 4 weeks.

Additional Recommendations

• Prepubescent boys with epididymitis require a urology referral due to a high incidence of urogenital abnormalities.
• Men over 50 should be evaluated for urethral obstruction due to prostatic enlargement.

Age Factors and Pathogens

• Men aged 14 to 35 years are most affected by epididymitis and orchitis.
• Common pathogens in this age group include Chlamydia trachomatis and Neisseria gonorrhoeae.

Physical Findings

• Typical findings include swollen, tender epididymis or testis in normal anatomical position with intact ipsilateral cremasteric reflex.

Prevalence and Causes

• Epididymitis is more common than orchitis.
• The primary cause of intrascrotal inflammation is epididymitis.
• Infections causing epididymitis in the 14-35 age group are predominantly from Neisseria gonorrhoeae and Chlamydia trachomatis.
• For those younger than 14 or older than 35, common urinary tract pathogens like Escherichia coli are typically responsible.

Risk Factors

• Risk factors for all men include:
  • Sexual activity
  • Strenuous physical activity
  • Bicycle or motorcycle riding
  • Prolonged sitting (e.g., during travel or sedentary jobs)
• In men over 35 and prepubertal boys, risk factors include:
  • Recent urinary tract surgery or instrumentation
  • Anatomic abnormalities (e.g., prostatic obstruction in older men, posterior urethral valves, meatal stenosis in boys)

Viral Infections and Orchitis

• Mumps is the most common cause of viral orchitis, which presents with abrupt unilateral scrotal pain and swelling.
• Orchitis associated with mumps generally appears 4 to 7 days after parotitis.

Torsion and Diagnosis

• Torsion of the appendix testis typically occurs in boys aged 7 to 14 years, rarely after age 20.
• Tenderness in the spermatic cord suggests epididymitis.
• A “blue dot” sign presents as bluish discoloration on the scrotal wall, indicative of infarction and necrosis.

Reflexes and Signs

• Cremasteric reflex is elicited by stroking the skin of the upper medial thigh, resulting in ipsilateral testis elevation in normal conditions.
• The cremasteric reflex is present in epididymitis and orchitis but absent in testicular torsion.
• Prehn's sign indicates relief of pain with elevation of the testis, typically seen in epididymitis.

Ultrasound Findings

• A normal testicle showing decreased Doppler wave pulsation suggests torsion.
• An enlarged, thickened epididymis with increased Doppler wave pulsation indicates epididymitis.

Treatment and Follow-up

• Antibacterial medications are unnecessary for viral orchitis; most cases resolve spontaneously within 3 to 10 days.
• Recommended follow-up is 3 to 7 days post-evaluation to check clinical improvement and for testicular mass presence.
• Pain management typically improves within 1 to 3 days, but full resolution of induration may take 2 to 4 weeks.

Additional Recommendations

• Prepubescent boys with epididymitis require a urology referral due to a high incidence of urogenital abnormalities.
• Men over 50 should be evaluated for urethral obstruction due to prostatic enlargement.

This quiz covers key aspects of epididymitis and orchitis, focusing on age factors, common pathogens, and physical findings. It highlights the prevalence and causes of these conditions, particularly in the male population aged 14 to 35 years. Test your understanding of risk factors and typical infections associated with these diseases.