From the Guidelines
For a patient with a history of epididymo-orchitis experiencing increased scrotal pain during cold temperatures, the most effective management approach is to combine symptomatic relief measures with strategies to address the cold-induced exacerbation of pain. The patient should be advised to wear supportive underwear or a scrotal support to minimize movement and provide warmth, as well as apply gentle heat to the area using warm compresses for 15-20 minutes several times daily to improve blood flow and reduce muscle tension 1. Over-the-counter pain medications such as ibuprofen (400-600mg every 6-8 hours) or naproxen (250-500mg twice daily) can help reduce pain and inflammation. Key considerations include:
- Avoiding cold exposure when possible
- Wearing additional layers or thermal underwear during cold weather
- Elevating the scrotum to reduce swelling, as recommended for patients with epididymo-orchitis 1
- Considering prescription medications for persistent pain, such as stronger NSAIDs or a short course of appropriate antibiotics if recurrent infection is suspected. The increased pain during cold temperatures is likely due to cold-induced vasoconstriction and increased muscle tension in the cremasteric muscles, which can exacerbate existing inflammation or sensitized nerve pathways from previous infection. If pain persists despite these measures, further evaluation by a urologist is necessary to rule out complications such as chronic epididymitis or testicular ischemia.
From the Research
Management Options for Epididymo-Orchitis
The management of epididymo-orchitis involves treating the underlying cause of the infection, which can be either sexually transmitted or caused by enteric bacteria 2, 3.
- For sexually active males under 35 years old, the most common pathogens are Neisseria gonorrhoeae and Chlamydia trachomatis, and treatment typically involves a single intramuscular dose of ceftriaxone with 10 days of oral doxycycline 3.
- For men over 35 years old, epididymitis is usually caused by enteric bacteria, and treatment typically involves levofloxacin or ofloxacin alone 3.
- In cases where the patient has a history of insertive anal intercourse, an enteric organism is also likely, and treatment typically involves ceftriaxone with 10 days of oral levofloxacin or ofloxacin 3.
Scrotal Pain and Cold Temperatures
There is limited information available on the specific relationship between scrotal pain and cold temperatures in patients with a history of epididymo-orchitis. However, it is known that cold temperatures can cause vasoconstriction, which may exacerbate scrotal pain in some individuals.
- Patients with a history of epididymo-orchitis may experience increased scrotal pain during cold temperatures due to the inflammatory response and potential damage to the epididymis and testis 4, 5.
- Management of scrotal pain in these patients typically involves treating the underlying cause of the pain, as well as providing supportive care such as analgesics and scrotal support 2, 6.
Diagnostic Considerations
It is essential to diagnose epididymo-orchitis accurately to provide appropriate treatment and prevent potential complications.
- Diagnostic procedures typically involve a physical examination, laboratory tests such as urinalysis and urine culture, and imaging studies such as ultrasound 2, 4.
- Patients with a history of epididymo-orchitis should be evaluated for potential underlying conditions such as bladder outlet obstruction, which can increase the risk of recurrent infections 2, 5.