PANCE Blueprint Genitourinary (5%)

Orchitis (Lecture)

Patient 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

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Question 1
A 12-year-old male presents with swelling and tenderness of the left testicle. Two weeks ago, he had a fever, loss of appetite, and tenderness and swelling under his ears, which resolved within 3 days. What is the recommended management?
A
Antibiotics to cover Gram-negative bacilli
Hint:
Bacterial orchitis occurs more commonly in older men and is treated the same as epididymitis
B
Fine needle aspirate of scrotal fluid
Hint:
See C for explanation
C
Ice and analgesia
D
Order a testicular ultrasound to rule out a mass
Hint:
If a testicular mass or torsion is suspect, ultrasonography and urgent referral are recommended.
E
Refer to urology for further workup
Hint:
If a testicular mass or torsion is suspect, ultrasonography and urgent referral are recommended.
Question 1 Explanation: 
The most common cause of orchitis in prepubescent males is mumps. Treatment is ice and analgesics, such as acetaminophen. Bacterial orchitis occurs more commonly in older men and is treated the same as epididymitis. If a testicular mass or torsion is suspect, ultrasonography and urgent referral are recommended.
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