When should a patient with epididymo-orchitis be referred to secondary care for further management?

Referral to secondary care for a patient with epididymo-orchitis should be arranged in the following situations:

• If the patient has severe symptoms, is systemically unwell, or there is a suspected serious complication such as testicular abscess or infarction, arrange emergency hospital admission for urgent assessment and management including possible intravenous antibiotics or surgical intervention.
• If symptoms worsen or do not improve after 3 days of appropriate antibiotic treatment, check compliance and investigations; if an enteric organism is confirmed, refer to urology to investigate for underlying structural or functional abnormalities or urinary tract obstruction.
• If there is uncertainty about diagnosis or management in primary care, seek urgent specialist advice or refer.
• If a sexually transmitted infection (STI) is suspected or confirmed and urgent referral to a local specialist sexual health clinic is not possible, start empirical treatment but arrange referral as soon as possible for testing, treatment, and contact tracing.
• If symptoms persist beyond 2 weeks despite treatment, consider arranging an ultrasound scan and/or referral to urology depending on clinical judgement.

These referral criteria are based on the British Association for Sexual Health and HIV (BASHH) guideline on epididymo-orchitis, the European Association of Urology (EAU) guideline on urological infections, and expert opinion in review articles.