Practice Essentials

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. Testicular examination reveals the following: testicular enlargement, induration of the testis, tenderness, erythematous scrotal skin, edematous scrotal skin, and enlarged epididymis associated with epididymo-orchitis. On rectal examination, there is a soft boggy prostate (prostatitis). often associated with epididymo-orchitis.^{[1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15]}

Orchitis most commonly occurs with epididymitis. Epididymitis is usually bacterial in origin; the most common pathogen is Neisseria gonorrhoeae in men aged 14-35 years, and Escherichia coli is the most common cause in boys younger than 14 years and in men older than 35 years. Viral orchitis is most often caused by mumps infection but can also be caused by a nonspecific inflammatory process in the testes.

Approximately 20% of prepubertal patients (younger than 10 years) with mumps develop orchitis. Unilateral testicular atrophy occurs in 60% of patients with orchitis.^[16] 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.

The symptoms of orchitis usually present several days after parotitis. Isolated bacterial orchitis is even more rare and is usually associated with a concurrent epididymitis; it occurs in sexually active males older than 15 years or in men older than 50 years with benign prostatic hypertrophy (BPH). Symptoms of isolated orchitis usually resolve spontaneously in approximately 3-10 days, whereas epididymitis will usually resolve in a similar time frame after initiation of antibiotic treatment.

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

Supportive treatment includes bed rest, hot or cold packs for analgesia, and scrotal elevation. With appropriate antibiotic coverage, most cases of bacterial orchitis resolve without complication.

Clinical Presentation

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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.

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