Orchitis

Background

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

Diagnosis

1. affected testicle/scrotum: swollen, tender, erythematous
2. testicular US shows testicular inflammation, rules out torsion, epididymitis
3. UA: positive in epididymo-orchitis

Work-Up

1. testicular US
2. UA, Urine Culture, gonorrhea, chlamydia screen

DDx

1. Testicular Torsion
2. Epididymitis
3. testicular tumor
4. mumps (or other viral) orchitis
5. lupus orchitis

Treatment

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

Disposition

1. admit for signs of systemic toxicity

Source

• Rosen's
• ER Atlas