Orchitis: Difference between revisions
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**<35yo (assume sexually transmitted): | **<35yo (assume sexually transmitted): | ||
***[[Ceftriaxone]] 250mg IM x1 '''AND''' | ***[[Ceftriaxone]] 250mg IM x1 '''AND''' | ||
***Doxycycline 100mg PO BID x14 days '''OR''' Azithromycin 1gm x1 | ***[[Doxycycline]] 100mg PO BID x14 days '''OR''' [[Azithromycin]] 1gm x1 | ||
***Also treat sexual partner | ***Also treat sexual partner | ||
**>35yo, history of anal intercourse or non-sexually active: | **>35yo, history of anal intercourse or non-sexually active: | ||
***Ofloxacin 300mg PO BID x14 days '''OR''' | ***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 | ***IV: [[piperacillin/taxobactam]] 3.375g IV q6 or [[ampicillin/sulbactam]] 3g IV q6 | ||
==Disposition== | ==Disposition== | ||
Revision as of 01:52, 14 July 2016
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
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, 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