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

Types of Orchitis

1. Mumps (or other viral) orchitis
2. Lupus orchitis

Testicular Diagnoses

• Scrotal cellulitis
• Epididymitis
• Fournier gangrene
• Hematocele
• Hydrocele
  • Hydrocele (peds)
• 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

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

See Also

• Testicular Pain

Source

• Rosen's
• ER Atlas