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.
To watch this and all of Joe Gilboy PA-C's video lessons you must be a member. Members can log in here or join now.
Orchitis is an infection of the testes 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
- Color Doppler ultrasonography to rule out other causes of acute scrotum (i.e. testicular torsion)
Treat with bed rest, NSAIDS, scrotal support, ice, and antibiotics (if bacterial)
Age <35 or sexually active postpubertal males (cover for GC/Chlamydia) - treat like epididymitis
- Ceftriaxone 500 mg IM once PLUS doxycycline 100 mg PO BID for 10 days
- Azithromycin 2 g PO once PLUS doxycycline 100 mg BID if severe PCN allergy
Age >35 (STI not suspected) - Levofloxacin 500 mg/d PO once daily for 10 days (21 days if associated prostatitis)
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. |
|
List |
References: Merck Manual · UpToDate
