Diagnosis of epididymo-orchitis

Epididymo-orchitis is a clinical diagnosis and should be made with the patient’s history and clinical symptoms.  It is important to differentiate epididymo-orchitis from a condition which represents similarly which is called torsion of the testis. Testicular torsion requires emergency management to save the testis.

    medical-history

    A medical history of the patient’s symptoms should be carefully evaluated

  • Medical History
  • A medical history of the patient’s symptoms should be carefully evaluated. Epididymo-orchitis has a rapid onset within 1 or 2 days whereas testicular torsion has an immediate onset. Epididymo-orchitis usually has no history of trauma whereas testicular torsion does. A sexual history is important in epididymo-orchitis. It should be determined if the patient has multiple sexual partners or neglects to use condoms. Other medical conditions and medications are also an important part of the history.
     

    medical_exam

    A general medical examination which includes temperature, blood pressure, pulse rate and a general systemic examination is always done first

  • Medical Examination
  • A general medical examination which includes temperature, blood pressure, pulse rate and a general systemic examination is always done first. A patient with epididymo-orchitis is likely to have a raised temperature and a raised pulse rate. Blood pressure will most likely be high due to pain but may also be low in severe infections.

    A medical examination of the genitals should be done by a medical professional to determine if epididymo-orchitis is present. In this condition the one side of the scrotum would be red, swollen and tender.

    In testicular torsion the scrotum may appear similar but the affected testicle would be slightly more raised than the other when the patient stands. If clinical differentiation between epididymo-orchitis and testicular torsion is difficult sonar of the testis should be done.

    During the medical examination it is important for the medical professional to look for signs which may determine the possible cause of the patient’s epididymo-orchitis. The patient may have a urinary tract infection or a urethral discharge may be noted at the urethral meatus.

    Urine-analysis-and-urine-dipstick

    A urinary tract infection is likely to be the cause of the patient’s epididymo-orchitis if a urine dipstick is positive for nitrates and leukocytes

  • Urine analysis and urine dipstick
  • A urinary tract infection is likely to be the cause of the patient’s epididymo-orchitis if a urine dipstick is positive for nitrates and leukocytes.

    Urine analysis is done to determine if an infection is present in the urine which may be the source of infection of the epididymo-orchitis. The urine may be sent for microscopy, culture and sensitivity. Treatment is usually started before this result becomes available.
     
     
     

  • Urethral discharge swab
  • If the patient has a urethral discharge, it may be swabbed and sent to the lab to determine the organisms involved.

  • Ultrasound
  • An ultrasound of the testis is done to differentiate epididymo-orchitis from testicular torsion. It is a non-invasive procedure and should not cause much pain.