History

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.

Epididymitis also occurs in most cases of mumps orchitis and results in epididymo-orchitis.^[20]

In a study by Tae et al, the clinical manifestations of mumps orchitis in 62 postpubertal vaccinated patients included a mean incubation period of 5.39 days (range, 0 to 23 days), a febrile duration of 1.8 days (range, 0.5 to 3 days), and a mean duration of orchitis of 4.96 days (range, 0 to 17 days). Sonography revealed unilateral orchitis in 58 patients (93.6%) and bilateral orchitis in 6 (6.4%). The mean age of the 62 patients was 17.56 years (range, 15 to 29 years).^[6]

Physical Examination

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. Mumps orchitis presents unilaterally in 70% of cases. In 30% of cases, contralateral testicular involvement follows by 1-9 days. Other findings include parotitis and fever

Differential Diagnoses

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Author

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.

Coauthor(s)

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.

Acknowledgements

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.