Orchitis Clinical Presentation
- Author: Nataisia Terry, MD; Chief Editor: Erik D Schraga, MD more...
Orchitis is characterized by testicular pain and swelling. The course is variable and ranges from mild discomfort to severe pain.
Associated systemic symptoms include the following:
Fever and chills
Mumps orchitis follows the development of parotitis by 4-7 days.
Obtain a sexual history, when appropriate.
Testicular examination reveals the following:
Induration of the testis
Erythematous scrotal skin
Edematous scrotal skin
Enlarged epididymis associated with epididymo-orchitis
On rectal examination, there is a soft boggy prostate (prostatitis). often associated with epididymo-orchitis.
Other findings include parotitis and fever.
Most commonly, mumps causes isolated orchitis. The onset of scrotal pain and edema is acute.
Because mumps orchitis is responsible for most cases of isolated orchitis, diagnosis in the ED usually is based on a reported history of a recent mumps infection or parotitis with a presentation of testicular edema.
Mumps orchitis presents unilaterally in 70% of cases. In 30% of cases, contralateral testicular involvement follows by 1-9 days.
Other rare viral etiologies include coxsackievirus, infectious mononucleosis, varicella, and echovirus. Some case reports have described mumps orchitis following immunization with the mumps, measles, and rubella (MMR) vaccine.
Bacterial causes usually spread from an associated epididymitis in sexually active men or men with BPH; bacteria include Neisseria gonorrhoeae, Chlamydia trachomatis, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus and Streptococcus species. Bacterial orchitis rarely occurs without an associated epididymitis.
Patients are usually sexually active and present with a gradual onset of pain and edema.
Unilateral testicular edema occurs in 90% of cases.
Immunocompromised patients have been reported to have orchitis with the following etiologic agents: Mycobacterium avium complex, Cryptococcus neoformans, Toxoplasma gondii, Haemophilus parainfluenzae, and Candida albicans.
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