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Orchitis

Orchitides


Presentation

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].

Painful Cough
  • The patient has denied any symptoms including dyspnea, chest pain, cough, fever, dysphagia, hemoptysis, weight loss, and weakness.[ncbi.nlm.nih.gov]
Dysphagia
  • The patient has denied any symptoms including dyspnea, chest pain, cough, fever, dysphagia, hemoptysis, weight loss, and weakness.[ncbi.nlm.nih.gov]
Testicular Pain
  • Acute testicular torsion is the most important differential diagnosis of acute testicular pain especially in younger men.[ncbi.nlm.nih.gov]
  • The patient presented with testicular pain and macroscopic scrotal changes requiring a left orchiectomy, with microbiological isolation and molecular confirmation of Histoplasma capsulatum.[ncbi.nlm.nih.gov]
  • An 18-year-old boy, a refugee from Afghanistan, with no significant medical history, presented after 1 day of severe left testicular pain. History, clinical examination and scrotal ultrasound suggested the diagnosis of epididymo-orchitis.[ncbi.nlm.nih.gov]
  • A 28-year-old heterosexual man presented to an emergency department with a 2-day history of left testicular pain and swelling that began after he started having unprotected sex with a new partner. He also had a 1-day history of fever and chills.[ncbi.nlm.nih.gov]
  • Testicular pain and swelling were the most common symptoms and elevation of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leucocytosis were the most common laboratory findings.[ncbi.nlm.nih.gov]
Testicular Swelling
  • A 65-year-old Kuwaiti man with poorly controlled diabetes mellitus presented with a painful left testicular swelling of 1 year duration. Testicular tumor markers were normal.[ncbi.nlm.nih.gov]
  • 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]
  • One month earlier, he underwent a partial orchidectomy of the right testis due to testicular swelling. Abdominal computed tomography showed a 3.8 cm wide aneurysm of the distal part of the aorta with inflammation.[ncbi.nlm.nih.gov]
  • Following 3 days of this treatment, the testicular swelling reduced considerably and orchidectomy was not required. Indeed, after a week, swelling was completely resolved and the patient was discharged.[ncbi.nlm.nih.gov]
  • Abstract Orchitis is common in adult male spinal cord injury (SCI) patients and, therefore, both health professionals and SCI patients themselves tend to attribute testicular swelling to orchitis, with a consequent potential delay in the diagnosis of[ncbi.nlm.nih.gov]
Swelling of the Scrotum
  • Pain and swelling in the scrotum should be evaluated by a doctor. Treatment of orchitis caused by bacteria includes antibiotics. Orchitis caused by a virus, such as mumps, is treated with rest and pain medicine.[myhealth.alberta.ca]
  • 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]
  • 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]
  • When to see a doctor If you have 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 require immediate treatment.[mayoclinic.org]
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]
  • This entity should be added to the differential diagnoses of testicular mass in the neonate even in the absence of physical findings suggestive of infection.[ncbi.nlm.nih.gov]
  • CONCLUSION: Adequate evaluation of patients with testicular mass by means of abdominal and scrotal ultrasound coupled with fine needle aspiration cytology is critical to diagnostic accuracy, optimal treatment and possibility of avoiding surgery in those[ncbi.nlm.nih.gov]
  • We present two cases undergoing orchiectomy because of testicular mass before the diagnosis of brucellosis was made.[ncbi.nlm.nih.gov]
  • It usually presents as a testicular mass which is highly suspicious of malignancy.[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]
  • At the same time, a painless right scrotal mass was observed. On imaging the testis and the epididymal mass both had abundant blood flow, although tumor markers were negative.[ncbi.nlm.nih.gov]
  • CASE REPORT: A 44-year old man presented with 4 months history of left scrotal mass and had left orchidectomy following a presumptive diagnosis of testicular tumour. Histopathological diagnosis of testicular tuberculosis was subsequently made.[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]
  • Evaluation of scrotal masses. Am Fam Physician. 2008 Nov 15. 78(10):1165-70. [Medline]. Walker NA, Challacombe B. Managing epididymo-orchitis in general practice. Practitioner. 2013 Apr. 257(1760):21-5, 2-3. [Medline].[emedicine.com]

Workup

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.

Mediastinal Mass
  • A 22-year-old male was referred to our department for further investigation of a mediastinal mass discovered incidentally during routine chest X-ray.[ncbi.nlm.nih.gov]
Toxoplasma Gondii
  • In patients with immunecompromised conditions, the common etiologic agents are Candida albicans, Toxoplasma gondii, and Haemophilus parainfluenzae. Among patients with orchitis, 6 in every 10 patients have unilateral testicular atrophy.[symptoma.com]

Treatment

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].

Prognosis

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.

Etiology

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].

Epidemiology

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].

Sex distribution
Age distribution

Pathophysiology

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].

Prevention

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].

Patient Information

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.

References

Article

  1. Krieger JN. Prostatitis, epididymitis, and orchitis. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone;2009:chap 109.
  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.

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Last updated: 2019-07-11 22:46