Orchitis

Background

Scrotal anatomy

Adult testicle with epididymis (left is posterior): A. Head of epididymis, B. Body of epididymis, C. Tail of epididymis, and D. Vas deferens.

• Inflammation of testis - can be infectious (usually) or non-infectious
• Infectious
  • Viral - most common etiology is mumps (orchitis seen in 20-30% of mumps patients)
    • Epididymis typically not involved
  • Bacterial - typically due to hematogenous spread from epididymis: "epididymo-orchitis"
    • (bacterial infections rarely involve only the testis)
    • bacterial pathogens: N. gonorrhea, C. trachomatis, E. Coli, Klebsiella, P. aeruginosa

Clinical Features

• Testicular tenderness, edema
• May see erythema of overlying scrotum
• Viral orchitis
  • Abrupt onset of scrotal pain/swelling 4-7 days after onset of parotitis
  • Usually unilateral
• Fever, tachycardia
• Inguinal lymphadenopathy
• Patient uncomfortable while seated

Differential Diagnosis

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

Evaluation

Work-Up

• Testicular ultrasound
• Urinalysis and urine culture
• May also consider GC, Chlamydia cultures

Evaluation

• Combination of clinical features and results of imaging/UA
• Ultrasound may show inflammation, epididymitis, and rules out active torsion
• Urinalysis positive for infection in epididymo-orchitis

Management

• Viral orchitis (mumps): supportive care, cold packs, scrotal elevation, analgesia.
• Bacterial orchitis (epididymo-orchitis):
  • <35yo (assume sexually transmitted):
    • Ceftriaxone 250mg IM x1 AND
    • Doxycycline 100mg PO BID x14 days OR Azithromycin 1gm x1
    • Also treat sexual partner
  • >35yo, history of anal intercourse or non-sexually active:
    • Ofloxacin 300mg PO BID x14 days OR levofloxacin 500mg QD x10 days OR ciprofloxacin 500mg PO BID x14 days
    • IV: piperacillin/taxobactam 3.375g IV q6 or ampicillin/sulbactam 3g IV q6

Disposition

• Generally may be discharged home

See Also

• Testicular Diagnoses