Orchitis: Difference between revisions
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#most common in prepubertal boys with viral infections (20% of patients with mumps) | #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 | ##arises several days after onset of flu-like symptoms and parotitis in mumps patients | ||
##Epididymis not involved; usually unilateral | |||
#bacterial orchitis typically due to spread from epididymis: epididymo-orchitis | #bacterial orchitis typically due to spread from epididymis: epididymo-orchitis | ||
##bacterial pathogens: N. gonorrhea, c. trachomatis, E. Coli, Klebsiella, P. aeruginosa | ##bacterial pathogens: N. gonorrhea, c. trachomatis, E. Coli, Klebsiella, P. aeruginosa | ||
##Differentiate from viral orchitis by involvement of epididymis, abscence of preceding parotid sx | |||
#presents with fever and scrotal pain | #presents with fever and scrotal pain | ||
Revision as of 02:52, 22 September 2011
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
- Epididymis not involved; usually unilateral
- bacterial orchitis typically due to spread from epididymis: epididymo-orchitis
- bacterial pathogens: N. gonorrhea, c. trachomatis, E. Coli, Klebsiella, P. aeruginosa
- Differentiate from viral orchitis by involvement of epididymis, abscence of preceding parotid sx
- 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
- Testicular Torsion
- Epididymitis
- testicular tumor
- mumps (or other viral) 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
- sexually transmitted (<35yo):
- treat sexual partner
Disposition
- admit for signs of systemic toxicity
Source
Adapted from Rosen's