Fact-sheet: Orchitis


Updated on 04/19/2018 at 6:40 PM

Note : 0/10
Share

View all RADEOS cases associated with this fact-sheet

Definition

Inflammation of the testis +/- epididymis

  • Population: young adult (STI = Chlamydiae and gonococcus)
  • adult > 50 years (UTI = E coli)
  • clinical diagnosis + urine culture

Clinical features

  • Clinical presentation: intense scrotal pain radiating along the spermatic cord
  • rapid but not sudden onset
  • positive Prehn's sign: relieved by elevation
  • fever, sometimes high
  • lower urinary tract symptoms
  • Physical examination: enlarged, tender, febrile hemiscrotum inflammatory scrotum, warm, shiny
  • +/- reactive Hydrocele
  • positive Chevassu's sign: loss of the epididymo-testicular groove

COMPLICATIONS:

  • abscess (rare)
  • acute testicular ischemia venous infarction due to compression
  • with intratesticular venous thrombi

Laboratory findings

  • Urine culture: to identify a causative organism of urinary tract infection
  • First-void urine PCR: chlamydia
  • urethral swab: gonococcus

Ultrasound

  • not mandatory!
  • only if resistant to medical treatment or in case of complication Orchitis: enlarged testis
  • hypoechoic
  • or striated hypoechoic appearance (enlarged vessels)
  • hypervascularized on Doppler
  • +/- Epididymitis: tail predominant++
  • enlarged epididymis
  • hypoechoic / heterogeneous
  • hypervascularized
  • Reactive Hydrocele
  • Thickening of the scrotal wall
  • hypervascularization on Doppler: decreased resistive indices

Management

  • Management
  • Outpatient treatment (unless complication)
  • Bed rest +/- sick leave
  • Symptomatic treatment
  • Analgesics-antipyretics: acetaminophen PO 3x1g/day
  • NSAIDs (except in cellulitis): prevent stricture and thus the risk of infertility
  • Scrotal support (in practice, tight underwear): relieves testicular pain
  • Curative treatment = Antibiotic therapy
  • Empiric antibiotic therapy +/- secondary adjustment based on antibiogram at follow-up visit at day 7 +++
  • Typical presentation in young patients: single-dose dual antibiotic therapy with IM third-generation cephalosporin + azithromycin PO 1g
  • Typical presentation in elderly patients: fluoroquinolone (ofloxacin) PO for 3 weeks (4-6 weeks if associated prostatitis)
  • Alternative if uncertain: single-dose third-generation cephalosporin + fluoroquinolone PO for 3 weeks (covers chlamydia and E. coli)

Differential diagnosis

  • Spermatic cord torsion ++ or torsion of sessile hydatid
  • Strangulated inguinal hernia++
  • Tuberculous epididymitis
  • Mumps orchitis or amiodarone-induced orchitis