Orchitis Treatment & Management

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

Emergency Department Care

Supportive treatment includes the following:

  • Bed rest

  • Hot or cold packs for analgesia

  • Scrotal elevation

Most importantly, the physician must rule out testicular torsion.

Second, the physician should consider epididymo-orchitis and, if highly suspected, treat appropriately. This usually involves starting empiric antibiotic therapy.

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Consultations

If torsion is likely, urologic consultation is required for urgent surgical exploration.

If a significant hydrocele is detected or suspected, urologic consultation is necessary to evaluate the need for a surgical tapping to relieve the pressure on the tunica.

Follow-up care with a urologist is appropriate for an uncomplicated presentation of orchitis.

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Medical Care

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.

Supportive therapy includes the following:

  • Bed rest

  • Scrotal support

  • Analgesics

  • Hot or cold packs for analgesia: Elevation of the scrotum and placement of ice on the affected testis are specific comfort measures that should be recommended to the patient with orchitis; the patient should put a small pillow or a towel between the legs to elevate the scrotum and place ice on the affected testis for 10-15 minutes, 4 times a day, until pain resolves

Patients with a suspected sexually transmitted disease should be referred to their private physician or local health department for HIV testing.

Treatment can usually be performed as an outpatient with close follow-up. Indications for admission include the following:

  • Inability to take oral antibiotics

  • Suspicion of abscess formation

  • Failure of previous outpatient therapy

  • Signs of sepsis

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Prevention

Pubertal and postpubertal males who have not received mumps vaccination are more susceptible to the virus and have a high risk of mumps orchitis. [11]

Mumps outbreaks have resulted in substantial increases in cases of orchitis. The mumps outbreak in England in 2004-2005 resulted in an increase in orchitis cases of up to 2 to 2.5 times in some populations (those born in the 1970s and 1980s). In comparison, during the years of low mumps incidence following introduction of the MMR vaccine, mumps-related orchitis was significantly reduced in those who did come down with the disease. [4, 23]

In the Czech Republic, 2-dose vaccinations against mumps showed a significant preventive effect agains the mumps complications of orchitis, meningitis, and encephalitis. However, complications increased with the time interval after vaccination. [24]

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