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  Orchitis
 
Author: Jonathan Jarow Last modified: March 19, 2002
DIAGNOSTIC CRITERIA

  EPIDEMIOLOGY

  • Orchitis is less common than epididymitis.
  • Blood-borne dissemination is the major route of testicular infection.
  • Genitourinary tract infections seldom involve the testis primarily with the exception of viral diseases.
  • Mumps is the most frequent cause of viral orchitis.
  • Pyogenic orchitis usually results from an inflammatory process in the epididymis.
  • Systemic dissemination of granulomatous infections may occasionally cause orchitis.

  RISK FACTORS

  • Immunodeficiency
  • Anatomic abnormalities of lower urinary tract
  • Urethral catheterization

  SIGNS AND SYMPTOMS

  • Scrotal pain
  • Scrotal swelling
  • Fever and chills with or without nausea

  DIFFERENTIAL DIAGNOSIS

  • Bacterial infection of the testis
  • Viral infection of the testis
  • Testicular abscess
  • Testicular torsion
  • Epididymitis
  • Vasculitis due to autoimmune disease
  • Testicular cancer

  LABORATORY FINDINGS

  • Urinary culture to rule UTI
  • Scrotal color flow ultrasound to differentiate from torsion and to identify abscess
  • ESR in patients with suspected vasculitis.
  • Tuberculous cultures and skin test in patients with suspected tuberculosis
  • CBC to rule out sepsis
 
TREATMENT
LOCAL CARE
  • Scrotal elevation
  • Compresses
  • Oral analgesics (ibuprofen 600 mg tid)
SYSTEMIC THERAPY
  • Intravenous antibiotics with broad spectrum coverage (aminoglycoside and ampicillin) for bacterial epididymo-orchitis.
  • Consider steroids (methylprednisolone 1.5 mg/kg/day) or Interferon-alpha 2B (3,000 IU/day x 1 week) for viral orchitis.
SURGICAL THERAPY
  • Scrotal exploration if torsion cannot be ruled out satisfactoriy.
  • Scrotal exploration and simple orchiectomy if testicular abscess is suspected.
  • Detorsion and bilateral orchidopexy if testicular torsion is found.
 
IMPORTANT POINTS/RECOMMENDATIONS
  • Acute scrotum is a urological emergency that requires prompt attention.
  • Testicular torsion must be ruled out in any patients with an acute scrotum regardless of patient age.
  • Orchitis secondary to a vasculitis is sometimes the presenting symptom of autoimmune disease.
  • Orchitis is sometimes due to rare infecting organisms such as Candida or Tuberculosis, particularly in immunodeficient patients.
  • Although testicular tumors are rarely symptomatic, testicular cancer must be ruled out.
 
REFERENCES
  1. Krieger JN ;  Epididymitis, orchitis, and related conditions. ;  Sex Transm Dis 1984 Jul-Sep;11(3):173-81

  2. Manson AL. ;  Mumps orchitis. ;  Urology 1990 Oct;36(4):355-8

  3. Hermansen MC, Chusid MJ, Sty JR ;  Bacterial epididymo-orchitis in children and adolescents. ;  Clin Pediatr (Phila) 1980 Dec;19(12):812-5

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