Orchitis: Difference between revisions

Revision as of 06:21, 9 September 2015

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

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
Pt uncomfortable while seated

Differential Diagnosis

Testicular Diagnoses

Diagnosis

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
UA 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, h/o 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

Disposition

Generally may be discharged home

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:

[Trojian-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.

[1]

@@ Line 1: / Line 1: @@
 ==Background==
-*rare acute infection of testis
+*Inflammation of testis - can be infectious (usually) or non-infectious
-*most common in prepubertal boys with viral infections (20% of patients with mumps)
+*Infectious
-**arises several days after onset of flu-like symptoms and parotitis in mumps patients
+**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 not involved; usually unilateral
+**Epididymis typically not involved
-*bacterial orchitis typically due to spread from epididymis: epididymo-orchitis
+**Bacterial - typically due to hematogenous spread from [[Epididymitis|epididymis]]: "epididymo-orchitis"
-**bacterial pathogens: N. gonorrhea, c. trachomatis, E. Coli, Klebsiella, P. aeruginosa
+***(bacterial infections rarely involve only the testis)
-**Differentiate from viral orchitis by involvement of epididymis, abscence of preceding parotid sx
+**bacterial pathogens: ''N. gonorrhea, C. trachomatis, E. Coli, Klebsiella, P. aeruginosa''
-*presents with fever and scrotal pain
-===Types of Orchitis===
-*Mumps (or other viral) orchitis
-*Lupus orchitis
 ==Clinical Features==
-*affected testicle/scrotum: swollen, tender, erythematous
+*Testicular tenderness, edema
+*May see erythema of overlying scrotum
+*Viral orchitis
+**Abrupt onset of scrotal pain/swelling 4-7 days after onset of parotitis<ref name="Trojian" />
+**Usually unilateral
+*Fever, tachycardia
+*Inguinal lymphadenopathy
+*Pt uncomfortable while seated
 ==Differential Diagnosis==
@@ Line 21: / Line 23: @@
 ==Diagnosis==
 ===Work-Up===
-*testicular US
+*Testicular ultrasound
-*UA, Urine Culture, gonorrhea, chlamydia screen
+*Urinalysis and urine culture
+*May also consider GC, Chlamydia cultures
 ===Evaluation===
-*testicular US shows testicular inflammation, rules out torsion, epididymitis
+*Combination of clinical features and results of imaging/UA
-*UA: positive in epididymo-orchitis
+*Ultraound may show inflammation, epididymitis, and rules out active torsion
+*UA positive for infection in epididymo-orchitis
-==Treatment==
+==Management==
-*viral orchitis (mumps): supportive care, ice, elevation, analgesia.
+*Viral orchitis (mumps): supportive care, cold packs, scrotal elevation, analgesia.
-*bacterial orchitis (epididymo-orchitis):
+*Bacterial orchitis (epididymo-orchitis):
-**sexually transmitted (<35yo):
+**<35yo (assume sexually transmitted):
-***[[ceftriaxone]] 250mg IM x1 or cipro 500mg PO x1 for [[gonorrhea]]
+***[[Ceftriaxone]] 250mg IM x1 '''AND'''
-***doxycycline 100mg PO BID x 14 days for [[chlamydia]]
+***Doxycycline 100mg PO BID x14 days '''OR''' Azithromycin 1gm x1
-**anal intercourse, nonsexually active, instrumentation and/or >35yo:
+***Also treat sexual partner
-***cipro 500mg PO BID x 14 days OR ofloxacin 200mg PO BID x 14 days
+**>35yo, h/o 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
-*treat sexual partner
 ==Disposition==
-*Admit for signs of systemic toxicity
+*Generally may be discharged home
 ==See Also==
@@ Line 46: / Line 50: @@
 ==References==
+<references/>
 [[Category:GU]]
 [[Category:ID]]