Orchitis: Difference between revisions
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*Inflammation of testis - can be infectious (usually) or non-infectious | *Inflammation of testis - can be infectious (usually) or non-infectious | ||
*Infectious | *Infectious | ||
**Viral - most common etiology is mumps (orchitis seen in 20-30% of mumps patients)<ref name="Trojian">Trojian, Thomas H., Timothy S. Lishnak, and Diana Heiman. "Epididymitis and orchitis: an overview." Am Fam Physician 79.7 (2009): 583-587.</ref> | **[[Viral syndrome|Viral]] - most common etiology is [[mumps]] (orchitis seen in 20-30% of mumps patients)<ref name="Trojian">Trojian, Thomas H., Timothy S. Lishnak, and Diana Heiman. "Epididymitis and orchitis: an overview." Am Fam Physician 79.7 (2009): 583-587.</ref> | ||
***Epididymis typically not involved | ***Epididymis typically not involved | ||
**Bacterial - typically due to hematogenous spread from [[Epididymitis|epididymis]]: "epididymo-orchitis" | **Bacterial - typically due to hematogenous spread from [[Epididymitis|epididymis]]: "epididymo-orchitis" | ||
***(bacterial infections rarely involve only the testis) | ***(bacterial infections rarely involve only the testis) | ||
***bacterial pathogens: ''N. gonorrhea, C. trachomatis, E. Coli, Klebsiella, P. aeruginosa'' | ***bacterial pathogens: ''[[N. gonorrhea]], [[C. trachomatis]], [[E. Coli]], [[Klebsiella]], [[P. aeruginosa]]'' | ||
==Clinical Features== | ==Clinical Features== | ||
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**Abrupt onset of scrotal pain/swelling 4-7 days after onset of parotitis<ref name="Trojian" /> | **Abrupt onset of scrotal pain/swelling 4-7 days after onset of parotitis<ref name="Trojian" /> | ||
**Usually unilateral | **Usually unilateral | ||
*Fever, tachycardia | *[[Fever]], [[tachycardia]] | ||
*Inguinal lymphadenopathy | *Inguinal [[lymphadenopathy]] | ||
*Patient uncomfortable while seated | *Patient uncomfortable while seated | ||
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===Evaluation=== | ===Evaluation=== | ||
*Combination of clinical features and results of imaging/UA | *Combination of clinical features and results of imaging/UA | ||
* | *[[Testicular ultrasound|Ultrasound]] may show inflammation, epididymitis, and rules out active torsion | ||
*[[Urinalysis]] positive for infection in epididymo-orchitis | *[[Urinalysis]] positive for infection in epididymo-orchitis | ||
==Management== | ==Management== | ||
*Viral orchitis (mumps): supportive care, cold packs, scrotal elevation, analgesia. | *Viral orchitis (mumps): supportive care, cold packs, scrotal elevation, [[analgesia]]. | ||
*Bacterial orchitis (epididymo-orchitis): | *Bacterial orchitis (epididymo-orchitis): | ||
**<35yo (assume sexually transmitted): | **<35yo (assume sexually transmitted): | ||
Revision as of 03:56, 24 September 2019
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
- Scrotal cellulitis
- Epididymitis
- Fournier gangrene
- Hematocele
- Hydrocele
- Indirect inguinal hernia
- Inguinal lymph node (Lymphadenitis)
- Orchitis
- Scrotal abscess
- Spermatocele
- Tinea cruris
- Testicular rupture
- Testicular torsion
- Testicular trauma
- Testicular tumor
- Torsion of testicular appendage
- Varicocele
- Pyocele
- Testicular malignancy
- Scrotal wall hematoma
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
- Ultrasound 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