Which investigations should be performed to confirm a diagnosis of epididymo-orchitis in a primary care setting?

Investigations to confirm a diagnosis of epididymo-orchitis in primary care include:

• Urine dipstick test to check for signs of urinary tract infection (UTI) such as leukocytes and nitrites.
• Mid-stream urine (MSU) sample for microscopy and culture to identify causative organisms.
• Assessment of risk factors for sexually transmitted infections (STIs) and consideration of first-pass urine or urethral swabs for nucleic acid amplification tests (NAAT) to detect gonorrhoea, chlamydia, and possibly Mycoplasma genitalium, depending on local availability.
• Clinical assessment to identify the most likely causative organism based on age, urine test results, and risk factors.
• If symptoms are severe or complications are suspected, urgent hospital referral and scrotal ultrasound may be required, but this is beyond primary care.

These investigations help guide appropriate management and antibiotic treatment in primary care or referral to specialist services if needed.

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