Epididymitis and Orchitis (Children) ✅

⚠️ Testicular pain is a common emergency presentation. Always first consider testicular torsion - a surgical emergency requiring urgent referral when suspected. Prompt assessment is critical, as the window for testicular salvage is narrow.

🦠 Causes

• 👉 Epididymitis:
  • Bacterial (UTI organisms: E. coli, Klebsiella, Proteus)
  • STIs in sexually active men (Chlamydia, Gonorrhea)
  • Urinary reflux (e.g., posterior urethral valves in children)
  • Trauma to the scrotum
• 👉 Orchitis:
  • Viral (e.g., mumps orchitis in unvaccinated individuals)
  • Bacterial – often part of epididymo‑orchitis
• 👉 Testicular torsion (emergency): sudden, severe pain with absent cremasteric reflex.
• 👉 Torsion of testicular appendage: may present similarly but is less urgent
• 👉 Other: trauma, tumour, hernia - consider if appropriate

🤒 Clinical Features

• 👉 Epididymitis:
  • Gradual onset scrotal pain and swelling
  • Red, warm, tender epididymis (pain may radiate to groin/abdomen)
  • ± Fever, dysuria if UTI/STI‑related
• 👉 Orchitis:
  • Testicular pain and swelling; may follow systemic viral symptoms
  • Tender erythematous testis
  • Mumps orchitis often occurs days after parotitis
• 👉 Testicular torsion:
  • Sudden severe unilateral pain; nausea/vomiting may occur
  • High‑riding, tender testis, absent cremasteric reflex
  • Negative Prehn’s sign does NOT reliably exclude torsion

Per NICE CKS, a diagnosis of testicular torsion should be suspected in any person presenting with acute scrotal pain and/or swelling before considering other causes.

🔬 Investigations

• 📉 Spirometry: (Not applicable here - focus on scrotal assessment)
• 📊 Clinical exam: must include palpation of testis position, tenderness, cremasteric reflex
• 🧲 Urinalysis & STI screen: in cases suspected of epididymitis/orchitis
• 🖥️ Scrotal Doppler ultrasound: only if not delaying urgent surgical referral when torsion is suspected, and useful to confirm blood flow where torsion is unclear

💊 Management

• 👉 Suspected Testicular Torsion:
  • Urgent referral to on‑call urology/surgical team - do not delay for imaging in high‑suspicion cases
  • Analgesia provided while arranging urgent transfer
• 👉 Epididymitis / Epididymo‑orchitis:
  • Rest, scrotal support, analgesia (NSAIDs ± paracetamol)
  • Empirical antibiotics guided by STI risk (e.g., ceftriaxone + doxycycline) or UTI features
  • Partner notification and STI testing where appropriate
• 👉 Orchitis (viral): supportive care; mumps orchitis does not require antivirals but may need ENT or public health advice

📌 Key exam tip: Testicular torsion = sudden onset, surgical emergency with absent cremasteric reflex. Epididymitis = gradual onset, often with urinary/STI features. Orchitis = testicular inflammation, may follow viral symptoms. Always rule out torsion first and refer urgently if suspected. 🚨

📚 NICE References

• NICE CKS: Scrotal pain and swelling (assessment & management)
• NICE CKS: Testicular torsion
• NICE CKS: Epididymo‑orchitis