Complications of Epididymo-Orchitis
Epididymo-orchitis can lead to serious complications including abscess formation, testicular ischemia, infertility, and chronic scrotal pain if not properly managed. 1
Major Complications
Immediate/Acute Complications
- Abscess formation: Can develop in untreated or inadequately treated cases
- Testicular ischemia: A rare but serious complication that may lead to testicular loss
- Systemic infection: Patients may become febrile and systemically unwell, requiring hospitalization for IV antibiotics and hydration 2
Long-term Complications
- Infertility: Approximately 40% of patients develop post-inflammatory subfertility 3
- Virulence factors like haemolysin A produced by uropathogenic E. coli have been shown to have a more negative impact on semen parameters compared to haemolysin A negative strains 3
- Chronic scrotal pain: May persist beyond the acute infection phase
- Testicular atrophy: Post-operative complication rates range from 9.1% to 47.5% 1
- However, with adequate antibiotic treatment, there is no strong evidence for testicular atrophy in most cases 3
- Recurrence: Approximately 10% of men experience recurrent epididymitis 3
- Recurrent cases should be thoroughly examined for subvesical obstruction
- Some patients with recurrent episodes may benefit from prophylactic vasectomy
Risk Factors for Complications
Age-Related Risk Factors
- Young adults (14-35 years): Complications often related to sexually transmitted infections (primarily N. gonorrhoeae and C. trachomatis) 1
- Men over 35 years: Complications frequently associated with enteric bacteria from urinary tract infections, often linked to bladder outlet obstruction 1, 4
Other Risk Factors
- Sexual practices: Men who practice insertive anal intercourse are at risk of complications from enteric organisms in addition to STIs 1
- Urological abnormalities: Benign prostatic hyperplasia, urethral stricture disease, or other functional bladder outlet problems increase risk of complications 4
- Delayed or inappropriate treatment: Increasing resistance to fluoroquinolones (traditionally used for enteric organism coverage) may lead to treatment failure and complications 4, 5
Prevention of Complications
Early Intervention
- Proper diagnosis: Ultrasound with Doppler is essential to confirm diagnosis and rule out underlying pathology 1
- Appropriate antibiotic therapy:
Supportive Care
- Bed rest, scrotal elevation, analgesics, and adequate fluid intake 1
- Application of heat or cold over the perineum 1
- Scrotal support/elevation and avoidance of activities that worsen symptoms 1
Follow-up and Monitoring
- Regular monitoring to assess for recurrence 1
- Consideration of surgical intervention for persistent symptoms despite appropriate antibiotic therapy 1
- For fertility concerns, obtain serum tumor markers (β-HCG, AFP, LDH) to rule out testicular malignancy before surgical intervention 1
- Consider sperm banking before surgical intervention if fertility is a concern 1
Special Considerations
- Mumps orchitis: Consider in non-immune individuals as a potential cause 5
- Tuberculosis: Consider in immunocompromised patients and men from countries with high TB prevalence 5
- Indwelling urethral catheters: These patients are at high risk of multiple drug resistance and should be treated empirically with both a fluoroquinolone and a third-generation cephalosporin until antimicrobial susceptibility testing is completed 3