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Please note: This page is intended for healthcare professionals only. It is designed as a general educational guide and does not replace local guidance, senior clinical advice, or individual clinical judgement. Patients should not use this page as medical advice and should seek advice from an appropriate healthcare professional.

Epididymo-Orchitis

Infection of the testicle, epididymis or both.

Common cause of acute scrotal pain in males aged 19-25 years and is responsible for most cases >25 years

Risk Factors

  • In sexually active men - most commonly caused by sexually transmitted organisms
  • In older men – often enteric pathogens and can be associated with bladder outflow obstruction (BOO), recent instrumentation, systemic illness

Assessment

  1. History
    1. Typically, gradual onset over days
    2. Can be associated with LUTS and urethral discharge
    3. Fevers
    4. Pain constant, but worse on walking
  2. Examination
    1. Hot, tender, erythematous, swollen hemiscrotum
    2. +ve Prehn's sign (pain relief with lifting the affected testicle)

Investigations

  1. Urine dip and urine culture
  2. Chlamydia & gonorrhoea urine PCR
  3. Bloods IF severe infection - FBC, CRP, U&Es
  4. USS testes if suspected other pathology or complications (?abscess ? tumour)
  5. Post-void residual in recurrent infections including UTIs / preceding voiding LUTS / older patients

Management

Antibiotics – choice is as per local microbiology guidelines.

Common protocol:

  1. Clinically well – oral antibiotics 2/52
    • < 35y: 1 dose 1g IM Ceftriaxone + Doxycycline 100mg BD
    • 35y+: fluoroquinolones (Levofloxacin / Ofloxacin / Ciprofloxacin)
  2. Clinically unwell
    • Admit for IV antibiotics
    • +/- Sepsis-6 (see HERE)
    • Think other differentials that can mimic scrotal pain (? Fournier's, ?infected obstructed kidney due to stone)
  3. Supportive measures
    • Scrotal support (jock strap / scrotal elevation)
    • Analgesia and NSAIDs
  4. Follow-up & Further Management
    • Advise to attend GUM clinic
    • Consider further investigations if recurrent

When to escalate

  • Clinically unwell patient requiring IV antibiotics
  • Suspected abscess formation
  • Suspected necrotising fasciitis (Fournier’s) – surgical emergency (read here)
  • Recurrent episodes requiring further investigation
  • Assess prostate for abscess in older men

References

  1. National Institute for Health and Care Excellence (NICE). Scrotal pain and swelling: epididymo-orchitis — management. Clinical Knowledge Summary, 2024. Available from: https://cks.nice.org.uk/topics/scrotal-pain-swelling/management/epididymo-orchitis/
  2. European Association of Urology. EAU Guidelines on Urological Infections. Arnhem: EAU Guidelines Office; 2026. Available from: https://uroweb.org/guidelines/urological-infections