Orchitis: Difference between revisions

Revision as of 10:47, 1 August 2015

Background

rare acute infection of testis
most common in prepubertal boys with viral infections (20% of patients with mumps)
- arises several days after onset of flu-like symptoms and parotitis in mumps patients
- Epididymis not involved; usually unilateral
bacterial orchitis typically due to spread from epididymis: epididymo-orchitis
- bacterial pathogens: N. gonorrhea, c. trachomatis, E. Coli, Klebsiella, P. aeruginosa
- Differentiate from viral orchitis by involvement of epididymis, abscence of preceding parotid sx
presents with fever and scrotal pain

Types of Orchitis

Mumps (or other viral) orchitis
Lupus orchitis

Clinical Features

affected testicle/scrotum: swollen, tender, erythematous

Differential Diagnosis

Testicular Diagnoses

Diagnosis

Work-Up

testicular US
UA, Urine Culture, gonorrhea, chlamydia screen

Evaluation

testicular US shows testicular inflammation, rules out torsion, epididymitis
UA: positive in epididymo-orchitis

Treatment

viral orchitis (mumps): supportive care, ice, elevation, analgesia.
bacterial orchitis (epididymo-orchitis):
- sexually transmitted (<35yo):
  - ceftriaxone 250mg IM x1 or cipro 500mg PO x1 for gonorrhea
  - doxycycline 100mg PO BID x 14 days for chlamydia
- anal intercourse, nonsexually active, instrumentation and/or >35yo:
  - cipro 500mg PO BID x 14 days OR ofloxacin 200mg PO BID x 14 days
  - IV: piperacillin/taxobactam 3.375g IV q6 or ampicillin/sulbactam 3g IV q6
treat sexual partner

Disposition

Admit for signs of systemic toxicity

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-#rare acute infection of testis
+*rare acute infection of testis
-#most common in prepubertal boys with viral infections (20% of patients with mumps)
+*most common in prepubertal boys with viral infections (20% of patients with mumps)
-##arises several days after onset of flu-like symptoms and parotitis in mumps patients
+**arises several days after onset of flu-like symptoms and parotitis in mumps patients
-##Epididymis not involved; usually unilateral
+**Epididymis not involved; usually unilateral
-#bacterial orchitis typically due to spread from epididymis: epididymo-orchitis
+*bacterial orchitis typically due to spread from epididymis: epididymo-orchitis
-##bacterial pathogens: N. gonorrhea, c. trachomatis, E. Coli, Klebsiella, P. aeruginosa
+**bacterial pathogens: N. gonorrhea, c. trachomatis, E. Coli, Klebsiella, P. aeruginosa
-##Differentiate from viral orchitis by involvement of epididymis, abscence of preceding parotid sx
+**Differentiate from viral orchitis by involvement of epididymis, abscence of preceding parotid sx
-#presents with fever and scrotal pain
+*presents with fever and scrotal pain
-==Diagnosis==
+===Types of Orchitis===
-#affected testicle/scrotum: swollen, tender, erythematous
+*Mumps (or other viral) orchitis
-#testicular US shows testicular inflammation, rules out torsion, epididymitis
+*Lupus orchitis
-#UA: positive in epididymo-orchitis
+==Clinical Features==
+*affected testicle/scrotum: swollen, tender, erythematous
-==Work-Up==
+==Differential Diagnosis==
-#testicular US
+{{Testicular DDX}}
-#UA, Urine Culture, gonorrhea, chlamydia screen
-==DDx==
+==Diagnosis==
-===Types of Orchitis===
+===Work-Up===
-#Mumps (or other viral) orchitis
+*testicular US
-#Lupus orchitis
+*UA, Urine Culture, gonorrhea, chlamydia screen
-===Other Diagnoses===
+===Evaluation===
-{{Template:Testicular DDX}}
+*testicular US shows testicular inflammation, rules out torsion, epididymitis
+*UA: positive in epididymo-orchitis
 ==Treatment==
-#viral orchitis (mumps): supportive care, ice, elevation, analgesia.
+*viral orchitis (mumps): supportive care, ice, elevation, analgesia.
-#bacterial orchitis (epididymo-orchitis):
+*bacterial orchitis (epididymo-orchitis):
-##sexually transmitted (<35yo):
+**sexually transmitted (<35yo):
-###[[ceftriaxone]] 250mg IM x1 or cipro 500mg PO x1 for [[gonorrhea]]
+***[[ceftriaxone]] 250mg IM x1 or cipro 500mg PO x1 for [[gonorrhea]]
-###doxycycline 100mg PO BID x 14 days for [[chlamydia]]
+***doxycycline 100mg PO BID x 14 days for [[chlamydia]]
-##anal intercourse, nonsexually active, instrumentation and/or >35yo:
+**anal intercourse, nonsexually active, instrumentation and/or >35yo:
-###cipro 500mg PO BID x 14 days OR ofloxacin 200mg PO BID x 14 days
+***cipro 500mg PO BID x 14 days OR ofloxacin 200mg PO BID x 14 days
-###IV: piperacillin/taxobactam 3.375g IV q6 or ampicillin/sulbactam 3g IV q6
+***IV: piperacillin/taxobactam 3.375g IV q6 or ampicillin/sulbactam 3g IV q6
-#treat sexual partner
+*treat sexual partner
 ==Disposition==
-#admit for signs of systemic toxicity
+*Admit for signs of systemic toxicity
 ==See Also==
 *[[Testicular Diagnoses]]
-==Source==
+==References==
-*Rosen's
-*ER Atlas
 [[Category:GU]]
 [[Category:ID]]