[Orchi-epididymitis].Ann Urol (Paris). 2003 Dec; 37(6):322-38.AU
The term orchiepididymitis encompasses inflammation of the epididymis and/or testis, i.e. epididymitis, orchitis, and true orchiepididymitis. Epididymitis is defined as inflammation of the epididymis. Young adults are predominantly affected, with a frequency peak between 20 and 40 years of age. The cause is usually an infectious agent, and the main route of access to the epididymis is retrograde propagation through the vas deferens. From puberty to 35 years of age, many cases are sexually transmitted. The main causative agents are Chlamydia trachomatis and Neisseria gonorrhoeae. In prepubertal children and in adults older than 35 years of age, epididymitis is among the commonplace genitourinary infections usually caused by enterobacteria. A urinary tract abnormality, most notably an obstruction of the distal urinary tract, is often the cause of the infection. Orchitis, a less common condition, is defined as inflammation of the testis. Again, most cases are related to an infection. Dissemination of the organism occurs either via the bloodstream, particularly with viruses (the most classic example being orchitis due to mumps) or by direct spread from a focus in the epididymis (producing true orchiepididymitis). In patients younger than 35 years of age who have urethritis and suspected sexually transmitted disease, tetracyclines are the best agents and can be given intravenously at first if needed. Tetracyclines are effective not only on C. trachomatis but also on N. gonorrhoeae. This last agent also responds to other antimicrobials, such as ceftriaxone. Macrolides and second-generation quinolones are also effective on C. trachomatis. Typically, treatment is given for 3 weeks. Sexual partners should be evaluated and treated. In patients older than 35 years who have positive urine cultures for bacteria, urinary tract symptoms, a prior diagnosis of a urinary tract abnormality, or a history of a recent endourethral procedure, treatment can be given orally provided the symptoms are of moderate intensity. Either extra-strength cotrimoxazole or second-generation quinolones should be used. Patients with severe disease should be admitted for parenteral therapy with an aminoglycoside and a cephalosporin in combination, followed by oral cotrimoxazole or a second-generation quinolone. If needed, the antibiotics should be changed according to antibiotic susceptibility test results.