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

  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]

• Painful Cough

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

• Numbness of the Hand

  One week later he was admitted to the hospital with numbness of his hands and feet. Physical examination showed signs of peripheral microemboli. [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]

• 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

  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]

  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]

• 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. . Accessed Sept. 29, 2018. Condition: Epididymitis/Orchitis. American Pediatric Surgical Association. . [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]

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]

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.