Orchitis Clinical Presentation

Updated: Aug 16, 2017
  • Author: Nataisia Terry, MD; Chief Editor: Erik D Schraga, MD  more...
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Presentation

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.

The clinical manifestations of mumps orchitis in 62 postpubertal vaccinated patients included mean incubation period 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). [9]

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Physical

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.

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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.

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.

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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Complications

Up to 60% of affected testes demonstrate some degree of testicular atrophy. Impaired fertility is reported at a rate of 7-13%. Sterility is rare in cases of unilateral orchitis. An associated hydrocele or pyocele may require surgical drainage to relieve pressure from the tunica. In one study of 7 patients who were followed after mumps orchitis (4 unilateral, 3 bilateral), in the unilateral orchitis group, 1 patient had an atrophic testis, 3 had severe oligozoospermia, and 1 had mild oligozoospermia. In the bilateral orchitis group, none had atrophic testes, and findings of semen analysis revealed azoospermia in 1 and severe oligozoospermia in 2 patients. Findings of semen analysis in most patients improved gradually. [17]

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