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Orchitis Clinical Presentation

  • Author: Nataisia Terry, MD; Chief Editor: Erik D Schraga, MD  more...
Updated: Sep 11, 2015


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:

  • 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.



Testicular examination reveals the following:

  • Testicular enlargement
  • Induration of the testis
  • Tenderness
  • 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.

Contributor Information and Disclosures

Nataisia Terry, MD Resident Physician, Department of Emergency Medicine, Kings County Hospital, State University of New York Downstate Medical Center

Nataisia Terry, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Society for Academic Emergency Medicine, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.


Walter W Valesky, Jr, MD Clinical Assistant Instructor, Department of Emergency Medicine, Kings County Hospital, State University of New York Downstate Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians, 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.

Additional Contributors

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, American Medical Informatics Association, Medical Association of Georgia

Disclosure: Nothing to disclose.


Mark B Mycyk, MD Associate Professor, Department of Emergency Medicine, Northwestern University Feinberg 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.

  1. Gazibera B, Gojak R, Drnda A, et al. Spermiogram part of population with the manifest orchitis during an ongoing epidemic of mumps. Med Arh. 2012. 66(3 Suppl 1):27-9. [Medline].

  2. Dogra V, Bhatt S. Acute painful scrotum. Radiol Clin North Am. 2004 Mar. 42(2):349-63. [Medline].

  3. Yagil Y, Naroditsky I, Milhem J, et al. Role of Doppler ultrasonography in the triage of acute scrotum in the emergency department. J Ultrasound Med. 2010 Jan. 29(1):11-21. [Medline].

  4. Artul S, Abu Rahmah Y, Abu Shkara H, Yamini A. Inferno: colour Doppler ultrasound sign of orchitis. BMJ Case Rep. 2014 Apr 1. 2014:[Medline]. [Full Text].

  5. Blaivas M, Sierzenski P, Lambert M. Emergency evaluation of patients presenting with acute scrotum using bedside ultrasonography. Acad Emerg Med. 2001 Jan. 8(1):90-3. [Medline].

  6. Schalamon J, Ainoedhofer H, Schleef J, Singer G, Haxhija EQ, Hollwarth ME. Management of acute scrotum in children--the impact of Doppler ultrasound. J Pediatr Surg. 2006 Aug. 41(8):1377-80. [Medline].

  7. Trojian TH, Lishnak TS, Heiman D. Epididymitis and orchitis: an overview. Am Fam Physician. 2009 Apr 1. 79(7):583-7. [Medline].

  8. Takeshima T, Yumura Y, Iwasaki A, Noguchi K. [Clinical Review of Hypospermatogenesis in Patients with a Previous Episode of Mumps Orchitis]. Hinyokika Kiyo. 2015 Jun. 61 (6):227-33. [Medline].

  9. Corbett HJ, Simpson ET. Management of the acute scrotum in children. ANZ J Surg. 2002 Mar. 72(3):226-8. [Medline].

  10. Garthwaite MA, Johnson G, Lloyd S, Eardley I. The implementation of European Association of Urology guidelines in the management of acute epididymo-orchitis. Ann R Coll Surg Engl. 2007 Nov. 89(8):799-803. [Medline]. [Full Text].

  11. Gift TL, Owens CJ. The direct medical cost of epididymitis and orchitis: evidence from a study of insurance claims. Sex Transm Dis. 2006 Oct. 33(10 Suppl):S84-8. [Medline].

  12. Lane TM, Hines J. The management of mumps orchitis. BJU Int. 2006 Jan. 97(1):1-2. [Medline].

  13. Manson AL. Mumps orchitis. Urology. 1990 Oct. 36(4):355-8. [Medline].

  14. Masarani M, Wazait H, Dinneen M. Mumps orchitis. J R Soc Med. 2006 Nov. 99(11):573-5. [Medline]. [Full Text].

  15. Pal G. The effects of pegylated interferon--alpha2B on mumps orchitis. J Indian Med Assoc. 2013 Sep. 111(9):612-4, 617. [Medline].

  16. Rosenstein D, McAninch JW. Urologic emergencies. Med Clin North Am. 2004 Mar. 88(2):495-518. [Medline].

  17. Shafik A, El-Sibal O, Shafik I. Electro-orchidogram: a non-invasive diagnostic tool in testicular pathologies. Med Sci Monit. 2006 Aug. 12(8):MT51-5. [Medline].

  18. Silva CA, Cocuzza M, Carvalho JF, Bonfá E. Diagnosis and classification of autoimmune orchitis. Autoimmun Rev. 2014 Apr-May. 13(4-5):431-4. [Medline].

  19. Ternavasio-de la Vega HG, Boronat M, Ojeda A, García-Delgado Y, Angel-Moreno A, Carranza-Rodríguez C, et al. Mumps orchitis in the post-vaccine era (1967-2009): a single-center series of 67 patients and review of clinical outcome and trends. Medicine (Baltimore). 2010 Mar. 89(2):96-116. [Medline].

  20. Tiemstra JD, Kapoor S. Evaluation of scrotal masses. Am Fam Physician. 2008 Nov 15. 78(10):1165-70. [Medline].

  21. Walker NA, Challacombe B. Managing epididymo-orchitis in general practice. Practitioner. 2013 Apr. 257(1760):21-5, 2-3. [Medline].

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