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
3. bacterial orchitis typically due to spread from epididymis: epididymo-orchitis
   1. bacterial pathogens: N. gonorrhea, c. trachomatis, E. Coli, Klebsiella, P. aeruginosa
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

1. tesicular torsion
2. epididymitis
3. testicular tumor
4. mumps (or other viral) orchitis
5. bacterial orchitis (epididymo-orchitis)
6. lupus orchitis

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

Source

Adapted from Rosen's