Orchitis: Difference between revisions
 
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==Background==
==Background==
#rare acute infection of testis
[[File:Gray1144.png|thumb|Scrotal anatomy]]
#most common in prepubertal boys with viral infections (20% of patients with mumps)
[[File:Epididymis-KDS.jpg|thumb|Adult testicle with epididymis (left is posterior): A. Head of epididymis, B. Body of epididymis, C. Tail of epididymis, and D. Vas deferens.]]
##arises several days after onset of flu-like symptoms and parotitis in mumps patients
*Inflammation of testis - can be infectious (usually) or non-infectious
#bacterial orchitis typically due to spread from epididymis: epididymo-orchitis
*Infectious
##bacterial pathogens: N. gonorrhea, c. trachomatis, E. Coli, Klebsiella, P. aeruginosa
**[[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>
#presents with fever and scrotal pain
***Epididymis typically not involved
**Bacterial - typically due to hematogenous spread from [[Epididymitis|epididymis]]: "epididymo-orchitis"
***(bacterial infections rarely involve only the testis)
***bacterial pathogens: ''[[N. gonorrhea]], [[C. trachomatis]], [[E. Coli]], [[Klebsiella]], [[P. aeruginosa]]''


==Diagnosis==
==Clinical Features==
#affected testicle/scrotum: swollen, tender, erythematous
*Testicular tenderness, edema
#testicular US shows testicular inflammation, rules out torsion, epididymitis
*May see erythema of overlying scrotum
#UA: positive in epididymo-orchitis
*Viral orchitis
**Abrupt onset of scrotal pain/swelling 4-7 days after onset of parotitis<ref name="Trojian" />
**Usually unilateral
*[[Fever]], [[tachycardia]]
*Inguinal [[lymphadenopathy]]
*Patient uncomfortable while seated


==Work-Up==
==Differential Diagnosis==
#testicular US
{{Testicular DDX}}
#UA, Urine Culture, gonorrhea, chlamydia screen


==DDx==
==Evaluation==
#[[Testicular Torsion]]
[[File:Ultrasonography of epididymitis.jpg|thumb|Doppler ultrasound of epididymitis, seen as a substantial increase in blood flow in the left epididymis (top image), while it is normal in the right (bottom image). The thickness of the epididymis (between yellow crosses) is only slightly increased.]]
#[[Epididymitis]]
===Work-Up===
#testicular tumor
*Testicular ultrasound
#mumps (or other viral) orchitis
*[[Urinalysis]] and urine culture
#lupus orchitis
*May also consider GC, Chlamydia cultures


==Treatment==
===Evaluation===
#viral orchitis (mumps): supportive care, ice, elevation, analgesia.  
*Combination of clinical features and results of imaging/UA
#bacterial orchitis (epididymo-orchitis):
*[[Testicular ultrasound|Ultrasound]] may show inflammation, epididymitis, and rules out active torsion
##sexually transmitted (<35yo):
*[[Urinalysis]] positive for infection in epididymo-orchitis
###ceftriaxone 250mg IM x1 or cipro 500mg PO x1 for gonorrhea
 
###doxycycline 100mg PO BID x 14 days for chlamydia
==Management==
##anal intercourse, nonsexually active, instrumentation and/or >35yo:
*Viral orchitis (mumps): supportive care, cold packs, scrotal elevation, [[analgesia]].  
###cipro 500mg PO BID x 14 days OR Ofloxacin 200mg PO BID x 14 days
*Bacterial orchitis (epididymo-orchitis):
###IV: piperacillin/taxobactam 3.375g IV q6 or ampicillin/sulbactam 3g IV q6
**<35yo (assume sexually transmitted):
#treat sexual partner
***[[Ceftriaxone]] 250mg IM x1 '''AND'''
***[[Doxycycline]] 100mg PO BID x14 days '''OR''' [[Azithromycin]] 1gm x1
***Also treat sexual partner
**>35yo, NO history of anal intercourse and NOT sexually active:
***Ofloxacin 300mg PO BID x14 days '''OR''' [[levofloxacin]] 500mg QD x10 days '''OR''' [[ciprofloxacin]] 500mg PO BID x14 days
***IV: [[piperacillin/tazobactam]] 3.375g IV q6 or [[ampicillin/sulbactam]] 3g IV q6


==Disposition==
==Disposition==
#admit for signs of systemic toxicity
*Generally may be discharged home
 
==See Also==
*[[Testicular Diagnoses]]


==Source==
==References==
Adapted from Rosen's
<references/>


[[Category:GU]]
[[Category:Urology]]
[[Category:ID]]
[[Category:ID]]

Latest revision as of 20:45, 17 August 2023

Background

Scrotal anatomy
Adult testicle with epididymis (left is posterior): A. Head of epididymis, B. Body of epididymis, C. Tail of epididymis, and D. Vas deferens.
  • Inflammation of testis - can be infectious (usually) or non-infectious
  • Infectious

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

Evaluation

Doppler ultrasound of epididymitis, seen as a substantial increase in blood flow in the left epididymis (top image), while it is normal in the right (bottom image). The thickness of the epididymis (between yellow crosses) is only slightly increased.

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

Disposition

  • Generally may be discharged home

See Also

References

  1. ↑ 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.
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