In orchitis, the patient experience mild to severe testicular pain and swelling. The other associated symptoms include fatigue, mylagias, fever, nausea, and severe headache. It is advisable to obtain the correct sexual history of the patients.

Testicular examination: Some of the observations that form a crucial part of the diagnosis of orchitis are the evaluation of testicular enlargement, and its tenderness. Other examinations include: induration of the testis, presence of erythematous or edematous scrotal skin, or enlarged epididymis.

Rectal examination: Patient with soft boggy prostate classifies as prostatitis and are often associated with epididymo-orchitis [6] [7] [8] [9].

• Fever

  Orchitis Definition Orchitis is an inflammation of the testis, accompanied by swelling, pain, fever, and a sensation of heaviness in the affected area. Description Viral mumps is the most common cause of orchitis. [medical-dictionary.thefreedictionary.com]

  BACKGROUND: Crimean-Congo haemorrhagic fever (CCHF) is a potentially fatal disease caused by a tick-borne virus. OBJECTIVES: A 53-year-old man presented with fever and acute painful scrotal swelling simulating acute epididymo-orchitis. [ncbi.nlm.nih.gov]

  || doi: 10.5694/j.1326-5377.2003.tb05072.x Published online: 20 January 2003 A 55-year-old taxi driver presented with a three-week history of intermittent sore throat associated with fever and rigors, which responded to paracetamol. [mja.com.au]

  He had fever, arthralgia and night sweats. Ultrasound examination revealed enlarged left epididymis and testicle. Brucella serology was positive and the patient responded to treatment with doxycycline and gentamicin. [scielo.br]

• Sepsis

  CASE PRESENTATION: A 69-year-old man arrived at our emergency department presenting with sepsis and acute scrotal pain. [ncbi.nlm.nih.gov]

  If symptoms of sepsis or systemic symptoms are present admission to hospital for rest and intravenous antibiotic treatment should be considered. [mshc.org.au]

  Features suggesting a lack of response to antibiotics include sepsis, pronounced scrotal oedema, severe testicular pain and scrotal wall inflammation [8]. [academic.oup.com]

  To our knlowledge, this is the first report of non-surgical management of neonatal pyocele secondary to EO.6 Because of the high risk of bacteremia and systemic infection in neonatal EO, early diagnosis including Doppler ultrasound and a full sepsis workup [elsevier.es]

• Surgical Procedure

  Lumbago कटिशूल, लूम्बेगो, कटिवात, Clinical applications include the control of pain in osteoarthritis, lumbago and migraine, and anaesthesia for certain surgical procedures, as well as other ... [dictionary.studysite.org]

  This may also occur after surgical procedures such as cystoscopy or catheterisation. Occasionally it may be caused by a ‘gut’ bacterial infection from insertive anal intercourse. [sexualwellbeing.ie]

  Unilateral salpingo-oophorectomy: A surgical procedure to remove one ovary and one fallopian tube. Total hysterectomy: A surgical procedure to remove the uterus, including the cervix. [my.clevelandclinic.org]

  Endourology[edit] Endourology is the branch of urology that deals with the closed manipulation of the urinary tract.[13] It has lately grown to include all minimally invasive urologic surgical procedures. [en.wikipedia.org]

  Thanks Dr Alex Satisfied Patient by Winston on Sep 15, 2018 I am very please and satisfied with everything that has been offorded to me by New York Urology Specialist Office.....Dr Alex Surgical Procedure by Lee St. [newyorkurologyspecialists.com]

• Anorexia

  No history of fever, cough, weight loss, anorexia or recent trauma could be elicited. Local examination showed an enlarged, firm, non-tender right testis. [ijri.org]

  Pyrexia, anorexia and hindlimb lameness in bacterial infections; scrotal swelling and edema. Diagnosis: history, clinical signs, semen evaluation, ultrasonography, testicular biopsy. Treatment: cold water bathing, antimicrobials, NSAIDs. [vetstream.com]

  KAWAKAMI, Yoshihiko SUZUKI, Masaru SATO, Yasuro ISAYAMA and Kiyoshi TABUCHI College of Environmental Health, Azabu University, 1-17-71 Fuchinobe, Sagamihara 229-8501, Japan SUMMARY A male sheed-zoo (shih tzu) dog aged two years living in Tokyo demonstrated anorexia [nichiju.lin.gr.jp]

  Shock - शाक (सदमा) Burns - जलना Hypothermia - शरीर का तापमान कम हो जाना Heat Stroke - लू लगना Acute Vomiting - तेज उल्टियां Dehydration - पानी की कमी Anaemia - रक्त की कमी Cough - खाँसी Eczema - एक्जिमा - पाया, छाजन Dyspepsia डिस्पेपशिया भुख ना लगना Anorexia [slunecnice.cz]

• Wound Infection

  The risk of a wound infection following an inguinal hernia operation with or without mesh should be below 5%. The use of mesh in inguinal hernia repair is not associated with a higher risk of wound infection. [dx.doi.org]

• Dyspnea

  The patient has denied any symptoms including dyspnea, chest pain, cough, fever, dysphagia, hemoptysis, weight loss, and weakness. [ncbi.nlm.nih.gov]

• Loss of Appetite

  Symptoms of Mumps Mumps can present in the following ways: Headache Muscle aches Fever Swollen glands Fatigue Loss of appetite Pain while chewing Swollen parotid, or salivary glands, are the hallmark of mumps, and people with swollen glands have "puffy [verywellhealth.com]

• Pelvic Mass

  It is particularly important as a sizeable ovarian mass may occupy most of the pelvic cavity, making it difficult to evaluate the contralateral ovary. [ncbi.nlm.nih.gov]

• Erythema

  The scrotal/testicular area was without tenderness or overlying erythema. Radical inguinal orchiectomy revealed diffuse gram-negative orchitis.This case represents an atypical presentation of orchitis. [ncbi.nlm.nih.gov]

  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. [smartypance.com]

  Coli, Klebsiella, P. aeruginosa Clinical Features Testicular tenderness, edema May see erythema of overlying scrotum Viral orchitis Abrupt onset of scrotal pain/swelling 4-7 days after onset of parotitis[1] Usually unilateral Fever, tachycardia Inguinal [wikem.org]

  Orchitis presents with testicular enlargement, pain and tenderness, scrotal erythema, and, in many cases, epididymal fullness or enlargement. Enzyme immunoassay for mumps immunoglobulin M antibodies is most commonly used for diagnosis. [aafp.org]

• Flushing

  It is also advisable to drink plenty of water so that infection in the body can be flushed out through the urine. Suggestion for Orchitis Orchitis may occur as a side effect of a medication known as amiodarone. [home-remedies-for-you.com]

• Testicular Pain

  Acute testicular torsion is the most important differential diagnosis of acute testicular pain especially in younger men. [ncbi.nlm.nih.gov]

  The testicular pain and swelling will last much longer. Untreated infection is more likely to lead to complications such as chronic testicular pain an abscess rarely testicular atrophy and loss of fertility More information www.bashh.org.uk [sexualhealthkingston.co.uk]

  If you do not get treatment, the testicular pain and swelling will last much longer. An untreated infection is more likely to lead to complications such as long-term testicular pain or an abscess. [sexualwellbeing.ie]

  If it is left untreated, it could lead to chronic epididymo-orchitis, where persistent testicular inflammation leads to recurring testicular pain. It can also lead to testicular shrinkage or testicular abscess (pus collection within the testicle). [leedssexualhealth.com]

• Testicular Swelling

  We want to convey the message that in HIV-positive patients presenting with testicular swelling, an infective aetiology should be considered. This will increase the possibility of early diagnosis and proper management. [ncbi.nlm.nih.gov]

• Swelling of the Scrotum

  Symptoms of orchitis include pain, swelling, or a feeling of heaviness in the scrotum. Orchitis can occur in men who get mumps, influenza, or tuberculosis. Sexually transmitted infections may also cause orchitis. [myhealth.alberta.ca]

  When to see a doctor If you experience pain or swelling in your scrotum, especially if the pain occurs suddenly, see your doctor right away. A number of conditions can cause testicle pain, and some of the conditions require immediate treatment. [fortishealthcare.com]

  Epididymo-orchitis is a condition characterised by pain and swelling in the scrotum. It is caused by infection and inflammation in the epididymis and/or testicle. Epididymitis means inflammation of the epididymis. [sexualhealthdorset.org]

  The primary complaint is swelling of the scrotum associated with pain. Urethral discharge is common. Fever may or may not be present. On palpation, swelling in the posterior scrotum localized over the involved epididymis can be appreciated. [visualdx.com]

  Pain and swelling of the scrotum (ball bag) effecting the epididymis (epididymitis), the testicles (orchitis) or both (epididymo-orchitis). [sexualhealthkingston.co.uk]

• Testicular Mass

  Rarely, patients may present with a testicular mass and it must be distinguished from malignant processes. We report brucellar orchitis, a rare cause of testicular mass, in a 22-year-old man. [ncbi.nlm.nih.gov]

• Scrotal Mass

  The clinical presentations of tuberculous epididymo-orchitis included scrotal mass (80%), scrotal pain (44%), micturition syndrome (8%), urethral discharge (4%), and scrotal fistula (4%). One third of the patients had pulmonary tuberculosis. [ncbi.nlm.nih.gov]

  Differential diagnosis of scrotal masses by ultrasound. Eur Radiol 1997; 7:668-679 [Google Scholar] 6. Kim SH, Pollack HM, Cho KS, Pollack MS, Han MC. Tuberculous epididymitis and epididymoorchitis: sonographic findings. [ajronline.org]

  Scrotal mass (adult). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017. Orchitis. Merck Manual Professional Version. https://www.merckmanuals.com/professional/genitourinary-disorders/penile-and-scrotal-disorders/orchitis. [mayoclinic.org]

The laboratory tests are not very helpful in the diagnosis of orchitis. In sexually active males, the urethral cultures and gram-stain must be obtained to determine the presence of bacteria. Urinalysis and erythrocyte sedimentation rate (ESR) also helps to ascertain the extent of inflammation in the patient.

Mumps in patients can be diagnosed with assessment of medical history and serum immune-fluorescence antibody testing. Since the diagnosis of mumps can be made easily based on medical history and physical examination, it can be a good approach to diagnose orchitis associated with bacterial infection. Acute scrotum can be tested with the help of color Doppler ultrasonography.

Patients with orchitis needs supportive treatment. Bed rest, hot or cold packs for pain-relief and scrotal elevation is suggested for physical relief of the patients. 

Depending on the extent of orchitis, the treatment is scheduled. If the torsion (caused when the testicular blood vessels gets twisted) is observed, urgent surgery must be considered. In case of significant hydrocele, the urologist must evaluate the need of surgical tapping which is believed to relieve the pressure on the tunica. For uncomplicated orchitis, follow up care is advised.

For the management of viral orchitis, no medications are advised. However, for orchitis associated with epididymitis, appropriate antibiotics are prescribed. The patients who are less than 35 years of age and sexually active, ceftriaxone, doxycycline or azithromycin is advised. Patients who are older than 35 years, additional antibiotics in the form of fluoroquinolone or sulphamethoxazole-trimethoprim combination are advised [10].

Early diagnosis and treatment of the disease can help preserve the testis from getting damaged. In case the testis does not return to its original size and pain persists, further testing must be performed at the earliest to rule out testicular cancer. Mumps orchitis cannot be treated and there is increased chance of such patients to become sterile [5].

Complications

When orchitis is caused by mumps, the patient may see the shrinking of their testicles, which is often referred to as testicular atrophy. Sometimes, orchitis may also cause infertility. There are other complications reported in such patients, such as chronic epididymitis, testicular infarction, or scrotal abscess. Some patients experience acute pain due to torsion which is considered a surgical emergency.

The most common cause of orchitis is mumps virus. In the patients affected by orchitis, there is an onset of scrotal pain and edema which is often acute. In most cases, since mumps infection is the most common cause of orchitis, the diagnosis of the disease is done in the emergency department based on the reported history of mumps infection along with a testicular edema.

In about 7 out of 10 cases, the mumps orchitis is presented unilaterally while in 30% of the cases, contralateral testicular involvement is observed.

Some other rare etiological causes of orchitis are varicella, echovirus or coxsackievrus. The bacterial cause of orchitis can be attributed to the associated epididymitis in sexually active men.

The most common bacteria that cause such infections include: Escherichia coli, Klebsiella pneumoniae, Streptococcus species and Pseudomonas aeruginosa. In patients with immunecompromised conditions, the common etiologic agents are Candida albicans, Toxoplasma gondii, and Haemophilus parainfluenzae [1] [2].

Among patients with orchitis, 6 in every 10 patients have unilateral testicular atrophy. The chances of sterility in such patients are rare, and there is little evidence to suggest that this disease can develop into testicular tumor after an episode of orchitis.

80% of the patients with mumps orchitis are in the prepubertal age group (age<10 years). Since bacterial orchitis is associated with epididymitis, the age group that is affected is males older than 15 years. In patients with benign prostatic hyperplasia, the chances of orchitis increases and the age group, thus affected is men with ages >50 years [3].

This disease was reported as early as 5th century BC. The most common causes of orchitis are epididymitis, which is caused by bacteria and viral orchitis due to mumps infection [4].

Early vaccination for mumps can help prevent orchitis caused by this disease. Practicing safer sexual behavior such as being faithful to a single partner (monogamy), use of condoms, and maintaining personal hygiene can help reduce the chances of orchitis due to sexually transmitted infection [4].

Orchitis is defined as the acute inflammation of the testis due to infection. Patient may observe an altered size of the testis, which can be small (testicular atrophy) or large (testicular enlargement). Patient can also experience tenderness in the testis or enlarged epididymis.

There can be excruciating pain in the scrotum or testicles in such patients. The cause of this distress is torsion which often is accompanied by pain. If there is a sudden pain in the scrotum or testis, seeking medical attention is mandatory.

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2. 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.
3. Dogra V, Bhatt S. Acute painful scrotum. Radiol Clin North Am. Mar 2004;42(2):349-63.
4. Trojian TH, Lishnak TS, Heiman D. Epididymitis and Orchitis: An Overview. Am Fam Physician. 2009;79:583-587
5. Manavi K, Turner K, Scott GR, Stewart LH. Audit on the management of epididymoorchitis by the Department of Urology in Edinburgh Int J STD AIDS. 2005;16(5):386–387.
6. Redfern TR, English PJ, Baumber CD, McGhie D. The aetiology and management of acute epididymitis Br J Surg. 1984;71(9):703–705.
7. Somekh E, Gorenstein A, Serour F. Acute epididymitis in boys: evidence of a post-infectious etiology J Urol. 2004;171(1):391–394.
8. 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. Jan 2010;29(1):11-21. 
9. Blaivas M, Sierzenski P, Lambert M. Emergency evaluation of patients presenting with acute scrotum using bedside ultrasonography. Acad Emerg Med. Jan 2001;8(1):90-3
10. Ludwig M. Diagnosis and therapy of acute prostatitis, epididymitis and orchitis Andrologia. 2008;40(2):76–80.