Orchitis: Practice Essentials

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Orchitis

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Overview

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

Dogra V, Bhatt S. Acute painful scrotum. Radiol Clin North Am. 2004 Mar. 42(2):349-63. [Medline].
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].
Trojian TH, Lishnak TS, Heiman D. Epididymitis and orchitis: an overview. Am Fam Physician. 2009 Apr 1. 79(7):583-7. [Medline].
Corbett HJ, Simpson ET. Management of the acute scrotum in children. ANZ J Surg. 2002 Mar. 72(3):226-8. [Medline].
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].
Lane TM, Hines J. The management of mumps orchitis. BJU Int. 2006 Jan. 97(1):1-2. [Medline].
Masarani M, Wazait H, Dinneen M. Mumps orchitis. J R Soc Med. 2006 Nov. 99(11):573-5. [Medline]. [Full Text].
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].
Tae BS, Ham BK, Kim JH, Park JY, Bae JH. Clinical features of mumps orchitis in vaccinated postpubertal males: a single-center series of 62 patients. Korean J Urol. 2012 Dec. 53 (12):865-9. [Medline].
Tomich A, Grubish L, Young S, Franklin J. Immunocompetent, Immunized Male With Mumps, Complicated by Orchitis and Meningitis. Mil Med. 2015 Oct. 180 (10):e1121-2. [Medline].
Davis NF, McGuire BB, Mahon JA, et al. The increasing incidence of mumps orchitis: a comprehensive review. BJU International. Available at http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2009.09148.x/full. April 2010; Accessed: August 26, 2016.
Masarani M, Wazait H, Dinneen M. Mumps orchitis. Journal of the Royal Society of Medicine. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1633545/. November 2006; Accessed: August 26, 2016.
Yamashita S, Umemoto H, Kohjimoto Y, Hara I. Xanthogranulomatous orchitis after blunt testicular trauma mimicking a testicular tumor: A case report and comparison with published cases. Urol J. 2017 May 23. 14 (3):3094-3096. [Medline].
Janssen KM, Willis CJ, Anderson M, Gelnett MS, Wickersham EL, Brand TC. Filariasis Orchitis-Differential for Acute Scrotum Pathology. Urol Case Rep. 2017 Jul. 13:117-119. [Medline].
Chu CY, Chen WY, Yeh SD, Yeh HM, Fang CL. Syphilitic orchitis mimicking a testicular tumor in a clinically occult HIV-infected young man: a case report with emphasis on a challenging pathological diagnosis. Diagn Pathol. 2016 Jan 14. 11:4. [Medline].
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].
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].
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].
Akaboshi I. Elevation of Serum Levels of High-Sensitivity Procalcitonin, C-reactive Protein, and Amyloid A in a Prepubertal Child with Mumps Orchitis. Clin Lab. 2015. 61 (11):1795-8. [Medline].
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].
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].
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].
Yung CF, Ramsay M. Estimating true hospital morbidity of complications associated with mumps outbreak, England, 2004/05. Euro Surveill. 2016 Aug 18. 21 (33):[Medline].
Orlíková H, Malý M, Lexová P, Šebestová H, Limberková R, Jurzykowská L, et al. Protective effect of vaccination against mumps complications, Czech Republic, 2007-2012. BMC Public Health. 2016 Apr 1. 16:293. [Medline].
Manson AL. Mumps orchitis. Urology. 1990 Oct. 36(4):355-8. [Medline].
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].
Pal G. The effects of pegylated interferon--alpha2B on mumps orchitis. J Indian Med Assoc. 2013 Sep. 111(9):612-4, 617. [Medline].
Rosenstein D, McAninch JW. Urologic emergencies. Med Clin North Am. 2004 Mar. 88(2):495-518. [Medline].
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].
Tiemstra JD, Kapoor S. Evaluation of scrotal masses. Am Fam Physician. 2008 Nov 15. 78(10):1165-70. [Medline].
Walker NA, Challacombe B. Managing epididymo-orchitis in general practice. Practitioner. 2013 Apr. 257(1760):21-5, 2-3. [Medline].

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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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