LecturePatient will present as → a 31-year-old male complaining of unilateral scrotal swelling with pain radiating to the ipsilateral groin. Examination reveals a tender swollen testicle, scrotal edema with erythema and shininess of the overlying skin.
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Orchitis is caused by ascending bacterial infection from the urinary tract
- Mumps is a common cause in kids
- Orchitis develops in 20 to 25% of males with mumps; 80% of cases occur in patients less than 10 years old
- Orchitis without epididymitis is very uncommon in adults
Testicular torsion should be ruled out in all cases of new-onset testicular pain.
Urinalysis with cultures will show pyuria and bacteriuria with cultures positive for suspected organisms.
- Ultrasound is useful if abscess or tumor is suspected or to rule out torsion
Treat with bed rest, NSAIDS, scrotal support, ice and antibiotics (if bacterial)
Age <35 or sexually active postpubertal males (cover for GC/Chlamydia)
- Ceftriaxone 250 mg IM once + doxycycline 100 mg PO BID for 10 days:
- May substitute azithromycin 1 g PO once for doxycycline if tetracycline allergy
- Quinolones no longer recommended if suspect N. gonorrhea
Age >35 - Ofloxacin 300 mg PO BID or levofloxacin 500 mg/d PO for 10 days
Question 1 |
Antibiotics to cover Gram-negative bacilli Hint: Bacterial orchitis occurs more commonly in older men and is treated the same as epididymitis | |
Fine needle aspirate of scrotal fluid Hint: See C for explanation | |
Ice and analgesia | |
Order a testicular ultrasound to rule out a mass Hint: If a testicular mass or torsion is suspect, ultrasonography and urgent referral are recommended. | |
Refer to urology for further workup Hint: If a testicular mass or torsion is suspect, ultrasonography and urgent referral are recommended. |
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