AUTHOR: Glenn G. Fort, MD, MPH
DefinitionOrchitis is an inflammatory process (usually infectious) involving the testicles. Infection may be viral or bacterial and can be associated with infection of other male sex organs (prostate, epididymis, or bladder) or lower urogenital tract or sexually transmitted diseases often via hematogenous spread. Common causes are:
- Viral: Mumps-20% postpubertal; Coxsackie B virus
- Bacterial: Pyogenic via spread from involving epididymis; bacteria include Escherichia coli, Klebsiella pneumoniae, P. aeruginosa, Staphylococcus, Streptococcus or Rickettsia, Brucella spp.; in sexually active men: Neisseria gonorrhoeae and Chlamydia trachomatis
- Other:
- Viral-HIV-associated, Cytomegalovirus (CMV), Zika
- Fungi
- Cryptococcosis
- Histoplasmosis
- Candida
- Blastomycosis
- Syphilis
- Mycobacterium tuberculosis and M. leprae
- Parasitic causes: Toxoplasmosis, filariasis, schistosomiasis
- Table 1 describes a classification of epididymitis and orchitis based on etiology
TABLE 1 Classification of Epididymitis and Orchitis
| Acute Epididymitis or Epididymo-Orchitis | Granulomatous Epididymitis or Orchitis | Viral Orchitis |
|---|
| Neisseria gonorrhoeae | Mycobacterium tuberculosis | Mumps |
| Chlamydia trachomatis | Treponema pallidum | Enteroviruses |
| Escherichia coli | | |
| Streptococcus pneumoniae | Brucella spp. | |
| Klebsiella spp. | Sarcoid | |
| Salmonella spp. | Fungal | |
| Other urinary tract pathogens | Parasitic | |
| Idiopathic | Idiopathic | |
From Cohen J, Powderly WG: Infectious diseases, ed 2, St Louis, 2004, Mosby.
SynonymsEpididymo-orchitis
Testicular infection
Testicular inflammation
| ICD-10CM CODES | | N45.9 | Orchitis, epididymitis, and epididymo-orchitis without abscess | | A54.1 | Gonococcal orchitis | | A56.1 | Chlamydial orchitis | | N51.1 | Mumps orchitis |
|
Epidemiology & DemographicsPredominant OrganismThe leading cause of viral orchitis is mumps. The mumps virus rarely causes orchitis in prepubertal males but involves one or both testicles in nearly 30% of postpubertal males.
Physical Findings & Clinical Presentation
- Testicular pain, unilateral or bilateral swelling
- May have associated epididymitis, prostatitis, fever, scrotal edema, erythema, cellulitis
- Inguinal lymphadenopathy
- Acute hydrocele (bacterial)
- Rare development: Abscess formation, pyocele of scrotum, testicular infarction
- Spermatic cord tenderness may be present
- Granulomatous
Clinical presentation as described previously with possible history of acute viral illness or concomitant epididymitis
Differential Diagnosis
- Epididymo-orchitis-gonococcal
- Autoimmune disease
- Vasculitis
- Epididymitis
- Mumps, with or without parotitis
- Neoplasm
- Hematoma
- Spermatic cord torsion
- Behçet disease
Laboratory Tests
- CBC with differential
- Urinalysis
- Viral titer-mumps. Mumps immunoglobulin M (IgM) will be detectable after 5 days of onset of clinical mumps and remain positive for up to 4 wk. A reverse-transcriptase polymerase chain reaction (RT-PCR) on serum or buccal or oral swab is another option
- Urine culture for mumps virus
- Ultrasound of testicle to rule out abscess
- Urine nucleic acid amplification tests (NAATs) for Neisseria gonorrhoeae and Chlamydia trachomatis
Imaging StudiesUltrasound if abscess suspected
Consider tuberculous orchitis if symptoms fail to respond to standard antibacterial therapy, even in the absence of chest radiographic evidence of pulmonary tuberculosis.
Related ContentOrchitis (Patient Information)
Epididymitis (Related Key Topic)
Mumps (Related Key Topic)
