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Orchitis
From WikEM
Contents
Background
- Inflammation of testis - can be infectious (usually) or non-infectious
- Infectious
- Viral - most common etiology is mumps (orchitis seen in 20-30% of mumps patients)[1]
- Epididymis typically not involved
- Bacterial - typically due to hematogenous spread from epididymis: "epididymo-orchitis"
- (bacterial infections rarely involve only the testis)
- bacterial pathogens: N. gonorrhea, C. trachomatis, E. Coli, Klebsiella, P. aeruginosa
- Viral - most common etiology is mumps (orchitis seen in 20-30% of mumps patients)[1]
Clinical Features
- Testicular tenderness, edema
- May see erythema of overlying scrotum
- Viral orchitis
- Abrupt onset of scrotal pain/swelling 4-7 days after onset of parotitis[1]
- Usually unilateral
- Fever, tachycardia
- Inguinal lymphadenopathy
- Patient uncomfortable while seated
Differential Diagnosis
Testicular Diagnoses
- Testicular torsion
- Epididymitis
- Orchitis
- Torsion of testicular appendage
- Scrotal abscess
- Fournier gangrene
- Hydrocele
- Indirect inguinal hernia
- Hematocele
- Spermatocele
- Testicular trauma
- Testicular rupture
- Varicocele
- Inguinal lymph node (Lymphadenitis)
- Testicular tumor
- Cellulitis
- Tinea cruris
Evaluation
Work-Up
- Testicular ultrasound
- Urinalysis and urine culture
- May also consider GC, Chlamydia cultures
Evaluation
- Combination of clinical features and results of imaging/UA
- Ultraound may show inflammation, epididymitis, and rules out active torsion
- Urinalysis positive for infection in epididymo-orchitis
Management
- Viral orchitis (mumps): supportive care, cold packs, scrotal elevation, analgesia.
- Bacterial orchitis (epididymo-orchitis):
- <35yo (assume sexually transmitted):
- Ceftriaxone 250mg IM x1 AND
- Doxycycline 100mg PO BID x14 days OR Azithromycin 1gm x1
- Also treat sexual partner
- >35yo, history of anal intercourse or non-sexually active:
- Ofloxacin 300mg PO BID x14 days OR levofloxacin 500mg QD x10 days OR ciprofloxacin 500mg PO BID x14 days
- IV: piperacillin/taxobactam 3.375g IV q6 or ampicillin/sulbactam 3g IV q6
- <35yo (assume sexually transmitted):
Disposition
- Generally may be discharged home
See Also
References
- ↑ 1.0 1.1 Trojian, Thomas H., Timothy S. Lishnak, and Diana Heiman. "Epididymitis and orchitis: an overview." Am Fam Physician 79.7 (2009): 583-587.
Authors
Michael Holtz, Ross Donaldson, Mark Russell, Claire, Daniel Ostermayer, Neil Young
