Introduction
Background
Orchitis is an acute inflammatory reaction of the testis secondary to infection. Most cases are associated with a viral mumps infection; however, other viruses and bacteria can cause orchitis.
Pathophysiology
Hippocrates first reported the syndrome in the 5th century BC. While the more common epididymo-orchitis is bacterial in origin, isolated orchitis usually has a viral etiology.
Frequency
United States
Approximately 20% of prepubertal patients with mumps develop orchitis. This condition rarely occurs in postpubertal males with mumps. Bacterial orchitis is even more rare and is usually associated with a concurrent epididymitis.
Mortality/Morbidity
- Unilateral testicular atrophy occurs in 60% of patients with orchitis.
- Sterility is rarely a consequence of unilateral orchitis.
- Despite some anecdotal reports, little evidence supports an increased likelihood of developing a testicular tumor after an episode of orchitis.
Age
- In mumps orchitis, 4 out of 5 cases occur in prepubertal males (younger than 10 years).
- In bacterial orchitis, most cases are associated with epididymitis (epididymo-orchitis), and they occur in sexually active males older than 15 years or in men older than 50 years with benign prostatic hypertrophy (BPH).
Clinical
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.
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
- Stool for occult blood
- Other
- Parotitis
- Fever
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.
More on Orchitis |
 Overview: Orchitis |
| Differential Diagnoses & Workup: Orchitis |
| Treatment & Medication: Orchitis |
| Follow-up: Orchitis |
| References |
| Next Page » |
References
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Further Reading
Keywords
orchitis, viral orchitis, bacterial orchitis, epididymo-orchitis, mumps orchitis, testicular pain, testicular swelling, inflammation of the testis, viral mumps infection, epididymitis, testicular atrophy, benign prostatic hypertrophy, BPH, parotitis, testicular edema
