A. Presentation

1. Often acute, painful swelling of testicle (usually unilateral)
2. Systemic signs and symptoms including fever, nausea

B. Causes

1. Viral Orchitis [1]
   1. Most common in young men
   2. Particularly associated with mumps
   3. Also occurs in children, often with varicella zoster [2]
2. Pyogenic (bacterial) orchitis usually secondary to epididymitis
3. Tuberculosis associated orchitis
4. Hydrocele may predispose to infectious orchitis
5. Autoimmune disease associated orchitis (usually associated with vasculitis)
6. Idiopathic granulomatous orchitis

C. Diagnosis

1. Urinalysis with cultures
2. Complete Blood Count (CBC)
3. Ultrasonography should be performed in ill patients

D. Treatment

1. Young men - usually symptomatic treatment with acetaminophen and fluids
2. Bacterial Infection
   1. Depends on organism
   2. TMP/SMX (such as Bactrim®) is often used
   3. Fluoroquinolones are probably more reliable for empiric therapy
   4. Ciprofloxacin, ofloxacin or levofloxacin
3. Autoimmune diseases - glucocorticoids ± cytotoxic therapies

References

1. Manson AL. 1990. Urology. 36(4):355
2. Liu HC, Tsai TC, Chang PY, Shih BF. 1994. Pediatr Infect Dis J. 13(8):748