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Orchitis Workup

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

Laboratory Studies

Laboratory tests are often not helpful in making the diagnosis of orchitis in the ED. Diagnosing mumps orchitis can be comfortably made based on history and physical examination alone. Diagnosing mumps orchitis can be confirmed with serum immunofluorescence antibody testing.

In sexually active males, urethral cultures and gram stain should be obtained for Chlamydia trachomatis and N gonorrhea. Urinalysis and urine culture should also be obtained.

Obtaining a C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) may also be helpful, because elevations of these are more suggestive of inflammation associated with epididymo-orchitis.


Imaging Studies

Color Doppler ultrasonography has become the imaging test of choice for the evaluation of an acute scrotum.[2, 3, 4]

Because orchitis often presents as acute edema and pain of the testicle, ruling out testicular torsion is critical. A finding of a normal-sized testicle with decreased flow is suggestive of torsion, whereas a finding of an enlarged epididymis with thickening and increased flow is more suggestive of epididymitis/orchitis.

Often, the history and physical examination are enough to make the diagnosis; however, as an adjunct, ultrasonography is highly sensitive for ruling out testicular torsion and for demonstrating inflammation of the testis or the epididymis.[5, 6]



If torsion is likely or if several hours have passed before the patient arrives in the ED, operative exploration is indicated.

Orchitis complicated by a reactive hydrocele or pyocele may require surgical drainage to reduce the pressure in the tunica.

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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