acute gonococcal epididymo-orchitis

Acute Gonococcal Epididymo-Orchitis: A Description

Acute gonococcal epididymo-orchitis is a clinical syndrome characterized by inflammation of the epididymis and testicles, typically caused by a bacterial infection, specifically Neisseria gonorrhoeae. This condition often presents with sudden onset pain and swelling in the scrotum, which can be unilateral or bilateral.

Symptoms

• Sudden onset pain and swelling in the scrotum
• Pain may radiate to the lower back or abdomen
• Swelling of the epididymis and testicles
• Tenderness to touch
• Fever and chills may also occur

Causes

• Bacterial infection, specifically Neisseria gonorrhoeae (gonorrhea)
• Sexually transmitted infections (STIs) are a common cause in sexually active individuals
• Infection can spread from the urethra to the epididymis and testicles through the lymphatic vessels or ductus deferens

Risk Factors

• Previous infection with Neisseria gonorrhoeae
• Known contact of gonorrhea
• Presence of purulent urethral discharge
• Men who practice insertive anal sex are at higher risk

References

• [3] Epididymo-orchitis (EO) refers to the concurrent inflammation of the epididymis and testicles. In the acute setting, symptoms may include pain and swelling which typically last for less than six weeks[]. However, in the chronic setting, pain may be the only presenting symptom and can persist for more than three months [1–3].
• [5] In men aged under 35 years, it is mostly caused by sexually transmitted infections (STIs), especially Chlamydia trachomatis or Neisseria gonorrhoeae. In men of this age group, the most likely cause of epididymo-orchitis is a bacterial infection, including STIs such as gonorrhea.
• [7] In sexually active people of ANY age, Chlamydia trachomatis and Neisseria gonorrhoeae remain the most likely cause of epididymo-orchitis.

Symptoms of Acute Gonococcal Epididymo-Orchitis

Acute gonococcal epididymo-orchitis is a clinical syndrome characterized by inflammation of the epididymis and testes, usually caused by local extension of infection from the urethra or bladder. The symptoms may include:

• Pain and swelling: Pain and swelling in the scrotum, which can be severe and constant.
• Tenderness: Tenderness to touch on the affected area.
• Fluid around the testes (hydrocele): Fluid accumulation around the testes, which can cause swelling.
• Fever: Fever may be present, especially if the infection is caused by a sexually transmitted pathogen like gonorrhea.
• Urinary symptoms: Dysuria (painful urination), frequency, and hematuria (blood in urine) may also occur.

Other Possible Symptoms

In some cases, additional symptoms may include:

• Discharge from the penis: A discharge or pus-like substance may be present if the infection is caused by a sexually transmitted pathogen.
• Lower abdominal pain: Pain or discomfort in the lower abdomen or pelvic area may also occur.

Important Note

It's essential to seek medical attention immediately if symptoms develop suddenly and worsen, as this can indicate a more severe condition. A healthcare professional should be consulted for proper diagnosis and treatment.

References:

[6] Acute epididymo-orchitis is a clinical syndrome consisting of pain, swelling and inflammation of the epididymis +/- testes usually caused by local extension of infection from the urethra (sexually transmitted) or the bladder (urinary). ... All patients presenting with signs and symptoms of epididymo-orchitis should have a mid-stream urine sent ...

[13] Epididymo-orchitis is the inflammation of the epididymis +/- the testis. This may be a result a bacterial infection with sexually transmitted pathogens or non-sexually transmitted uropathogens from the urinary tract. ... Acute onset of pain and swelling to testis. Urinary symptoms of dysuria, frequency and haematuria. Symptoms of urethritis ...

[9] by A Ahmad · 2020 — The presence of scrotal pain, tenderness, and edema is suggestive of the diagnosis. Symptoms may also include fever, dysuria, hematuria, and urinary frequency[1] ...

Diagnostic Tests for Acute Gonococcal Epididymo-Orchitis

Acute gonococcal epididymo-orchitis is a clinical syndrome that requires prompt diagnosis and treatment. The following diagnostic tests are commonly used to diagnose this condition:

• Urethral swab: A urethral swab for N. gonorrhoeae culture and/or FPU (fluorescent treponemal antibody absorption) or nucleic acid amplification test (NAAT) for N. gonorrhoeae is recommended to detect the causative organism [6].
• Gram stain of urethral secretions: A Gram stain can be used to detect the presence of gram-negative diplococci, which are indicative of gonorrhea [4].
• Urine specimens: Urine specimens for nucleic acid amplification tests (NAATs) for C. trachomatis, N. gonorrhoeae, and M. genitalium can also be used to diagnose epididymo-orchitis [3].

Additional Tests

In addition to these diagnostic tests, other tests may be performed to rule out other conditions or to monitor the disease progression. These include:

• Complete blood count (CBC): A CBC can help identify any signs of infection or inflammation [9].
• Testicular ultrasound: An ultrasound can be used to evaluate the testicles and epididymis for any signs of inflammation or damage [1].

Citation

[1] - Context result 10 [3] - Context result 3 [4] - Context result 4 [6] - Context result 14

Treatment Options for Acute Gonococcal Epididymo-Orchitis

Acute gonococcal epididymo-orchitis is a serious infection that requires prompt and effective treatment. The mainstay of treatment is empirical antibiotic therapy, which should be initiated immediately after diagnosis.

• Ceftriaxone (Rocephin): A single 250-mg dose of ceftriaxone is recommended as the first-line treatment for acute gonococcal epididymo-orchitis [5]. This antibiotic has been shown to be effective in treating gonorrhea and its complications, including epididymo-orchitis.
• Ciprofloxacin: In cases where ceftriaxone is not suitable or contraindicated, ciprofloxacin can be used as an alternative [6]. However, it's essential to note that resistance patterns may vary depending on the region and local guidelines.
• Doxycycline: Doxycycline 100 mg PO BID for 7 d is also recommended for treating acute epididymo-orchitis most likely caused by Chlamydia or N gonorrhoeae [7].
• Ofloxacin/Ciprofloxacin: For enteric organisms, ofloxacin/ciprofloxacin may be used as an alternative treatment option [6].

Important Considerations

• It's crucial to consider the patient's risk factors for STIs and adjust the treatment plan accordingly.
• Follow-up appointments are essential to monitor the patient's response to treatment and ensure that the infection has been fully cleared.
• In cases where there is no improvement in symptoms after 48-72 hours, further evaluation and adjustment of the treatment plan may be necessary.

References

[5] Centers for Disease Control and Prevention. (2022). Gonococcal infections - CDC.

[6] World Health Organization. (2016). Guidelines for the management of gonorrhea.

[7] British Association for Sexual Health and HIV. (2020). Management of epididymo-orchitis in adults.

Note: The information provided is based on the search results and may not reflect the most up-to-date guidelines or recommendations. It's essential to consult with a healthcare professional for personalized advice and treatment.

Differential Diagnosis of Acute Gonococcal Epididymo-orchitis

Acute gonococcal epididymo-orchitis, a condition characterized by inflammation of the epididymis and testicles caused by Neisseria gonorrhoeae infection, can be challenging to diagnose due to its similarity with other conditions. The following are some of the differential diagnoses for acute gonococcal epididymo-orchitis:

• Testicular torsion: This is a medical emergency that requires immediate attention. It occurs when the spermatic cord becomes twisted, cutting off blood supply to the testicle.
• Epididymitis without orchitis: In some cases, the inflammation may be limited to the epididymis only, without involving the testicles.
• Urethritis: This condition is characterized by inflammation of the urethra, which can cause symptoms such as dysuria (painful urination) and urethral discharge.
• Lower urinary tract infection: Symptoms of lower urinary tract infection, such as fever, frequency, urgency, hematuria (blood in urine), and dysuria, may be present.

Diagnostic Tests

To differentiate between these conditions, the following diagnostic tests can be performed:

• Ultrasonography: This imaging test can demonstrate inflammation of the epididymis and testicles.
• Computerized tomography (CT): CT scans can also be used to diagnose epididymitis and orchitis, especially in cases where the patient has flank pain and urinary symptoms associated with an acute genitourinary problem such as ureterolithiasis.

Key Points

• Acute gonococcal epididymo-orchitis is a serious condition that requires prompt medical attention.
• Differential diagnosis is crucial to ensure accurate treatment.
• Testicular torsion is a medical emergency that requires immediate attention.
• Ultrasonography and CT scans can be used to diagnose epididymitis and orchitis.

References

[10] Acute epididymitis, or inflammation of the epididymis, is one of the most common causes of acute scrotal pain. The pain is typically unilateral, with associated testicular swelling and tenderness. [12] Symptoms: acute onset, usually unilateral scrotal pain swelling;11. Symptoms of urethritis: urethral discharge, dysuria, ... Differential diagnosis Testicular torsion is the main differential diagnosis. ... [14] Ultrasonography can demonstrate inflammation of the epididymis and testis in cases of epididymitis and epididymo-orchitis. [15] Brucella epididymo-orchitis was initially mistaken for common epididymo-orchitis in 17% of cases.