Orchitis
Revision as of 10:47, 1 August 2015 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
- 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
Types of Orchitis
- Mumps (or other viral) orchitis
- Lupus orchitis
Clinical Features
- affected testicle/scrotum: swollen, tender, erythematous
Differential Diagnosis
Testicular Diagnoses
- Scrotal cellulitis
- Epididymitis
- Fournier gangrene
- Hematocele
- Hydrocele
- 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
Diagnosis
Work-Up
- testicular US
- UA, Urine Culture, gonorrhea, chlamydia screen
Evaluation
- testicular US shows testicular inflammation, rules out torsion, epididymitis
- UA: positive in epididymo-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