Synopsis
Distinguish epididymo-orchitis from testicular torsion, identify sexual and enteric causes, prescribe cause-directed therapy and complete partner and follow-up management.
- Epididymo-orchitis usually causes unilateral epididymal pain and swelling developing over hours to days; torsion is the time-critical mimic.
- Age alone does not determine cause: use sexual history, urethral symptoms, urinary pathology, anal exposure, instrumentation and culture.
- Send first-catch urine NAAT for gonorrhoea and chlamydia and midstream urine culture when enteric infection is possible.
Key red flags
Sudden severe pain or a high-riding testis requires immediate torsion assessment.
Abrupt severe pain, nausea, high-riding or horizontal testis and absent cremasteric reflex increases torsion probability and requires emergency urology.
Investigation priorities
Localise epididymal tenderness and assess torsion, hernia, abscess and perineal necrosis.
Management branches
Onset, testicular lie, nausea or examination creates meaningful suspicion of testicular torsion.
- Contact urology immediately, document onset, give analgesia, keep the patient fasted and prepare for emergency exploration.
- Do not wait for urine results, improvement after analgesia or routine outpatient ultrasound when suspicion is high.
Key medicines
Ceftriaxone plus doxycyclineGive ceftriaxone 1 g intramuscularly once plus doxycycline 100 mg orally twice daily for 10 to 14 days.
Ceftriaxone plus levofloxacinGive ceftriaxone 1 g intramuscularly once plus levofloxacin 500 mg orally once daily for 10 days.