Orchitis Clinical Presentation

  • Author: Mark B Mycyk, MD; Chief Editor: Erik D Schraga, MD   more...
 
Updated: May 5, 2010
 

History

  • Orchitis is characterized by testicular pain and swelling.
  • The course is variable and ranges from mild discomfort to severe pain.
  • Associated systemic symptoms
    • Fatigue
    • Malaise
    • Myalgias
    • Fever and chills
    • Nausea
    • Headache
  • Mumps orchitis follows the development of parotitis by 4-7 days.
  • Obtain a sexual history, when appropriate.
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Physical

  • Testicular examination
    • Testicular enlargement
    • Induration of the testis
    • Tenderness
    • Erythematous scrotal skin
    • Edematous scrotal skin
    • Enlarged epididymis associated with epididymo-orchitis
  • Rectal examination
    • Soft boggy prostate (prostatitis) often associated with epididymo-orchitis
  • Other
    • Parotitis
    • Fever
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Causes

  • 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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Contributor Information and Disclosures
Author

Mark B Mycyk, MD  Associate Professor, Department of Emergency Medicine, Boston University School of Medicine

Mark B Mycyk, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Eric M Kardon, MD, FACEP  Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center

Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Richard H Sinert, DO  Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

References

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