Epididymo-orchitis: Symptoms, Causes, and Treatment via UK Online Doctor

Epididymo-orchitis is a clinical condition characterised by inflammation of the epididymis (the tube at the back of the testicle that stores and carries sperm) and the testis itself. While these can occur independently, they often present together due to their anatomical proximity. In the United Kingdom, this condition is a frequent cause of acute scrotal pain in adult men.

According to NHS and NICE guidance, the management of epididymo-orchitis depends heavily on the likely underlying cause, which varies by age and sexual history. It is essential to distinguish this condition from testicular torsion, which is a surgical emergency requiring immediate hospital attendance.

The symptoms of epididymo-orchitis usually develop over a period of many hours or a few days. Patients typically report:

• Scrotal swelling: Often affecting only one side, the scrotum may appear larger and feel heavy.
• Localised pain: A dull ache that may become sharp, often radiating to the groin or abdomen.
• Redness and heat: The skin over the affected area may appear inflamed or shiny.
• Systemic symptoms: Fever, chills, and a general feeling of being unwell (malaise).
• Urinary symptoms: Pain during urination (dysuria), increased frequency, or a discharge from the urethra.

If you notice a sudden, severe onset of pain that occurs over seconds or minutes, you should seek emergency care immediately at an A&E department to rule out torsion.

Sexually Transmitted Infections (STIs)

In men under the age of 35, the most common causes of epididymo-orchitis in the UK are Chlamydia trachomatis and Neisseria gonorrhoeae. These bacteria travel from the urethra through the sperm ducts to reach the scrotum. Testing for STIs is a standard part of the diagnostic process in these cases.

Urinary Tract Infections (UTIs)

In men over 35, or those with recent urinary tract instrumentation (like a catheter), enteric bacteria such as E. coli are more frequent culprits. These infections are often associated with bladder outlet obstruction, such as an enlarged prostate.

Other Causes

Non-bacterial causes include the mumps virus, certain medications (like amiodarone), and occasionally trauma or reflux of urine into the epididymis due to heavy lifting or straining.

When you consult a healthcare professional, they will ask about your sexual history and any urinary symptoms. A physical examination is usually required to check for tenderness, swelling, and to see if the pain is slightly relieved by elevating the scrotum (known as Prehn's sign, though this is not definitive).

Standard investigations recommended by NICE include:

• A mid-stream urine (MSU) sample to check for bacterial infection.
• A urethral swab or a first-void urine sample for NAAT testing (to detect chlamydia and gonorrhoea).
• Occasionally, an ultrasound scan of the scrotum if the diagnosis is unclear or if an abscess is suspected.

The primary treatment for bacterial epididymo-orchitis is a course of antibiotics. Because results for STI tests can take several days, doctors often start 'empirical' treatment based on the most likely cause. For STI-related cases, this often involves a single antibiotic injection followed by a course of oral tablets, or a two-week course of oral antibiotics such as doxycycline or ofloxacin.

Supportive care includes:

• Analgesia: Over-the-counter paracetamol or ibuprofen to manage pain and inflammation.
• Scrotal support: Wearing supportive underwear (briefs rather than boxers) can significantly reduce discomfort.
• Rest: Avoiding heavy lifting and strenuous activity until the infection clears.

It is vital that sexual partners are informed and tested if an STI is suspected, and you should avoid sexual contact until the treatment is complete and symptoms have resolved.

If you are experiencing mild to moderate discomfort or have noticed a gradual swelling of the scrotum, you can speak to a GP online for a confidential consultation. This is a discreet way to discuss sexual health concerns, receive advice on necessary tests, and understand the potential causes of your symptoms.

An online doctor can:

• Assess your symptoms and provide a referral for specialised sexual health testing.
• Prescribe appropriate antibiotics if the cause is clearly identified or if you are awaiting a clinic appointment.
• Provide a clinical letter or sick note if your symptoms are severe enough to prevent you from working.
• Advise on the next steps if your symptoms do not improve after starting treatment.