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].

• Inguinal Lymphadenopathy

  Signs and symptoms include enlargement or tenderness of the affected testis, inguinal lymphadenopathy, blood in the semen, and pain during urination, intercourse, or ejaculation. Inflammation of one or both testis. [icd10data.com]

  Signs and symptoms include enlargement or tenderness of the affected testis, inguinal lymphadenopathy, blood in the semen, and pain during urination, intercourse, or ejaculation. Definition (CSP) inflammation of one or both testis. [fpnotebook.com]

  lymphadenopathy Patient uncomfortable while seated Differential Diagnosis Testicular Diagnoses Cellulitis Epididymitis Fournier gangrene Hematocele Hydrocele Indirect inguinal hernia Inguinal lymph node (Lymphadenitis) Orchitis Scrotal abscess Spermatocele [wikem.org]

• 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]

• Lymphadenopathy

  Lymphadenopathy and splenomegaly led us eventually to the diagnosis of sleeping sickness. After treatment with suramin his spermiogram returned to normal. [ncbi.nlm.nih.gov]

  Signs and symptoms include enlargement or tenderness of the affected testis, inguinal lymphadenopathy, blood in the semen, and pain during urination, intercourse, or ejaculation. Inflammation of one or both testis. [icd10data.com]

  Signs and symptoms include enlargement or tenderness of the affected testis, inguinal lymphadenopathy, blood in the semen, and pain during urination, intercourse, or ejaculation. Definition (CSP) inflammation of one or both testis. [fpnotebook.com]

  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 lymphadenopathy [wikem.org]

• Gangrene

  gangrene in atherosclerosis of native arteries of the extremities ( I70.26 ) gangrene in hernia ( K40.1, K40.4, K41.1, K41.4, K42.1, K43.1-, K44.1, K45.1, K46.1 ) gangrene in other peripheral vascular diseases ( I73.- ) gangrene of certain specified [icd10data.com]

  Abrupt onset of scrotal pain/swelling 4-7 days after onset of parotitis[1] Usually unilateral Fever, tachycardia Inguinal lymphadenopathy Patient uncomfortable while seated Differential Diagnosis Testicular Diagnoses Cellulitis Epididymitis Fournier gangrene [wikem.org]

  Necrotizing fasciitis (Fournier gangrene) – Pain is severe. Skin findings vary but may include edema, bullae, and crepitus. [visualdx.com]

  Rarely, serious damage to the testicle may occur and result in dead tissue (gangrene) in the testicle that needs to be surgically removed. [patient.info]

• Vascular Disease

  ICD-10-CM Codes › N00-N99 Diseases of the genitourinary system › N40-N53 Diseases of male genital organs › N45- Orchitis and epididymitis › Orchitis 2016 2017 2018 2019 Billable/Specific Code Male Dx N45.2 is a billable/specific ICD-10-CM code that can [icd10data.com]

  Vascular disease f. AAA g. COPD h. Prostatism i. Constipation j. Weight 3. How long the hernia has been present? Operation data 1. Operation date 2. Acute 3. Antibiotics 4. Thrombosis prophylaxis 5. 6. Day surgery 7. Recurrence a. [dx.doi.org]

• Ulcer

  शोथ, Endoscopy revealed retained food in the stomach but no evidence of pyloric stenosis, gastritis, or peptic ulcer. [dictionary.studysite.org]

  A 22-year-old adult presented with unilateral testicular enlargement and scrotal ulcer on the same side. FNAC was performed and subsequent smear examination revealed epitheloid granuloma in a necrotic background. [ncbi.nlm.nih.gov]

  Hemorrhagic bowel syndrome Hernias Osteochondrosis Other Pityriasis rosea Porcine stress syndrome Prolapse of the vagina and cervix Rectal prolapse Rectal stricture Shoulder ulcers Splay leg Sunburn Thrombocytopaenic purpura Torsion of the stomach and [pig333.com]

• Skin Ulcer

  […] effective 10/1/2015) : New code (first year of non-draft ICD-10-CM) 2017 (effective 10/1/2016) : No change 2018 (effective 10/1/2017) : No change 2019 (effective 10/1/2018) : No change Gangrene, gangrenous (connective tissue) (dropsical) (dry) (moist) (skin [icd10data.com]

• Suggestibility

  This was suggestive of tubercular orchitis, which was further confirmed by demonstration of very occasional acid fast bacilli in the smear. Isolated tuberculous orchitis is a rare entity; FNAC is a useful first choice of investigation. [ncbi.nlm.nih.gov]

  Taking history Onset: insidious presentation suggests infection. [bmj.com]

• Irritability

  This will remove bacteria from the area and relieve irritation. Also, use a product for sensitive skin to wash all your underwear. Some detergents can be strong and irritating. [medium.com]

  Clinical presentation Acute onset of pain and swelling to testis Urinary symptoms of dysuria, frequency and haematuria Symptoms of urethritis such as, urethral discharge and penile irritation Most important differential diagnosis is testicular torsion [aci.health.nsw.gov.au]

  A 19-day-old male was brought to the Emergency Department with an erythematous and firm swelling of his left scrotum associated with irritability and fever that had begun five hours before. [elsevier.es]

  Symptoms of a urinary tract irritation may also be present. These include burning pain when passing urine and an increased need to urinate. [netdoctor.co.uk]

• Stroke

  Epidiymo-orchitis अधिवृषण वृषणशोथ अन्डकोषो में सूजन 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 [slunecnice.cz]

  Neurological diseases and disorders such as a stroke, multiple sclerosis, Parkinson's disease, and spinal cord injury can disrupt the lower urinary tract and result in conditions such as urinary incontinence, detrusor overactivity, urinary retention, [en.wikipedia.org]

  The cremasteric reflex, elicited by stroking the skin of the upper medial thigh, should always be evaluated. [aafp.org]

  One crossover patient had a postoperative myocardial infarction and died, one patient had a postoperative stroke and one patient had an acute hernia. [dx.doi.org]

• 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.

• Pyuria

  Urinalysis with cultures will show pyuria and bacteriuria with cultures positive for suspected organisms. [smartypance.com]

  In the testicular torsion group, fewer patients had elevated C-reactive protein levels no patients had pyuria, and the pain duration was shorter compared with the epididymo-orchitis group (5/11 vs 13/22 [p = 0.045], 0/28 vs 8/28 [p = 0.004] and 27.0 vs [ncbi.nlm.nih.gov]

  It has many features of EPIDIDYMITIS, such as swollen SCROTUM; PAIN; PYURIA; and FEVER. [profiles.viictr.org]

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.