Orchitis

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

-bacterial orchitis typically due to spread from epididymis: epididymo-orchitis

    -bacterial pathogens: N. gonorrhea, c. trachomatis, E. Coli, Klebsiella, P. aeruginosa

-presents with fever and scrotal pain

Diagnosis

-affected testicle/scrotum: swollen, tender, erythematous

-testicular US shows testicular inflammation, rules out torsion, epididymitis

-UA: positive in epididymo-orchitis

Work-Up

-testicular US

-UA, Urine Culture, gonorrhea, chlamydia screen

DDx

-tesicular torsion

-epididymitis

-testicular tumor

-mumps (or other viral) orchitis

-bacterial orchitis (epididymo-orchitis)

-lupus 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

Source

Adapted from Rosens