Orchitis
Revision as of 12:34, 14 March 2011 by Rossdonaldson1 (talk | contribs)
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
- sexually transmitted (<35yo):
- treat sexual partner
Disposition
- admit for signs of systemic toxicity
Source
Adapted from Rosen's