Epididymitis - Six weeks antibiotic treatment recommended. If it does not show signs of progressive resolution, think of Chlamydia and TB (but do not necessarily expect to find organisms in the urine).

Testicular tumour - also a possibility. Refer for ultrasound and consultation. Also, please let us know if you have patients with post-operative epididymitis (TURs etc).

Sperm granuloma - after vasectomy can masquerade as chronic epididymitis. Ultrasound and refer.

Acute orchitis - Mostly virus infection (usually mumps). Mumps orchitis occurs only after puberty and most are unilateral. Testicular atrophy may follow - advise referral and ultrasound (steroids rather than testicular decompression may reduce the chance of atrophy).

Note on testicular torsion - included here because differentiation from epididymitis and orchitis is not always easy, especially when the patient presents a little while after the event when local signs appear inflammatory. History is important and previous episodes of sudden pain with rapid resolution are not are not uncommon in testicular torsion. It can occur at any age, although 10 - 20 years is the commonest. It may also occur at any time including during sleep. If there is a possibility of torsion, send the patient to the nearest A & E Department by any means immediately and ’phone the urology or General Surgical Firm on take at the same time.

Torsion of the appendix testis (may be a visible/palpable bluish lump at the upper pole in the early stages) - same applies, we explore them immediately.

Longterm indwelling catheter users and those with urinary diversions - will all have organisms in the urine. Treat only if patient has symptoms.