ORCHITIS

dr. Egi Edward Manuputty, Sp.U

Anatomy
TESTICLE HEALTH PROBLEMS
TESTICLE HEALTH PROBLEMS
 Definition
O Inflammatory reaction of the testis secondary to infection
O Orchitis most commonly occurs with epididymitis
 Who Gets Orchitis?
O Sexually active people

O Orchitis associated with mumps

usually occurs in children less
than 10 years of age

O Orchitis can occur in any age

group

O The causes of the Orchitis can

vary according to each age group
 Risk Factors of Orchitis
O Multiple sexual partners

O Men with prostate enlargement

O Trans urethral procedures (procedures done by passing a scope

through the urethra)

O Children who are not vaccinated against mumps

O Children with structural abnormality of the urinary tract

 What causes orchitis?
O Viral (Mumps virus)
O Bacterial and pyogenic infections (E. coli, Pseudomonas sp,
Staphylococcus sp, Streptococcus sp)
O Sexually transmitted bacteria : N. gonorrhoeae, T. pallidum,
and C. trachomatis)
O Mycobacterium, Fungal (Candida sp), and Parasite (worm)
O Autoimmune
Bacteria Viral
Neisseria Mumps
gonorrhoeae (less than 10
(14-35 years) years)

Chlamydia
trachomatis
(14-35 years)

Escherichia coli
(< 14 years and >
35 years)
Classification
Signs and Symptoms of Orchitis
O Swelling and pain of the testis (usually unilateral), bilateral
swelling often cause by virus

O Formation of reactive hydrocele (accumulation of fluid

around the testis)

O Orchitis is found in association with acute epididymitis in 20-

40% of the patients
 Associated systemic symptoms
include the following:
O Fatigue
O Malaise
O Myalgias
O Fever and chills
O Nausea
O Headache
 Physical Examination
Look Palpation
• Testicular enlargement • Induration of the testis
• Erythematous scrotal skin • Tenderness
• Edematous scrotal skin • Phren sign positive in epididymo-
orchitis
• Transillumination test positive in
reactive hydrocele

On rectal examination, there is a soft boggy prostate (prostatitis). often

associated with epididymo-orchitis.
 Workup
O Complete evaluation of medical history along with a thorough
physical exam

O Complete blood count (CBC) - increased WBCs may be seen

O Urinalysis for pyuria (the presence of pus cells) or bacteriuria

(the presence of bacteria)

O Urine culture may be performed for prepubertal and elderly

patients
 Workup
O Gram stain of urethral discharge, if present

O Urethral culture, nucleic acid hybridization, and nucleic acid

amplification tests: These tests can aid in the detection of N.
gonorrhoeae and C. trachomatis

O Performance of syphilis and HIV testing in patients with a

suspicion of sexually-transmitted etiology

O Doppler ultrasonography: It is done to rule-out testicular

torsion and to also evaluate chronic epididymitis
 Complications
O Scrotal abscess and pyocele
(pus surrounding the testis)

O Testicular infarction: Cord

swelling can limit testicular
blood flow

O Fertility issues

O Testicular atrophy: The testis

becomes small and functionless
 Treatment
O Anti-inflammatory agents such as NSAIDs
O Analgesics
O Antibiotics
 Antibiotics given 4 to 6 weeks against Chlamydia sp and
Neisseria gonorrhoea are recommended for those with
suspected sexually-transmitted condition.
 Antibiotics have to be administered to the sexual partners also,
to prevent recurrence of the condition
 In children and pre-pubertal males, antibiotics are given to
those with pyuria and positive urine culture
 Sensitivity of antibiotics in Indonesia

*Panduan penatalaksanaan infeksi saluran kemih dan genitalia pria. IAUI. 2015
 RECOMMENDED ANTIBIOTICS
The Centers for Disease Control and
Prevention’s guidelines :
O Ceftriaxone or Doxycycline/
Azithromycin for men younger than
age 35 years
O Levofloxacin or Ofloxacin for men
older than age 35 years
EAU Guideline :
O Low risk gonorrhoeae :
Fluoroquinolone 10 – 14 days or
Doxycycline 200 mg initial then
2x100 mg
O High risk GO : Ceftriaxone 500 mg
IM +Doxycycline 200 mg initial
then 2x100 mg for 10-14 days
O Non sexual active :
O Single agent for
Enterobacteriaceae or
Fluoroquinolone 10 – 14 days
 Supportive therapy
O Reduction in physical activity

O Scrotal support and elevation

O Use of ice packs

O Avoidance of urethral instrumentation

O Sitz baths (immersing the scrotum in a tub of warm water)

 Prevention
O Bacterial epididymo-orchitis can be prevented by proper
sexual hygiene and sterile precautions during any
transurethral procedures.
O The mumps-related orchitis can be prevented by MMR
vaccine administered during 12-15 months of age, followed
by a booster dose at the age of 4-6 years
 Prognosis
O The prognosis of Orchitis and Epididymo-Orchitis is generally good
with appropriate diagnosis and treatment

O Pain improves within 1-3 days, but induration may take several
weeks or months to resolve. Infection of the epididymis can lead
to the formation of an epididymal abscess

O Patients with sexually transmitted epididymo-orchitis have 2-5

times the risk of acquiring and transmitting an HIV infection
 References
O Trojian TH, Lishnak TS, Heiman D. Epididymitis and orchitis: an
overview. Am Fam Physician. 2009 Apr 1. 79(7):583-7.
O http://www.sti.guidelines.org.au/syndromes/epididymo-orchitis
O Garthwaite MA, Johnson G, Lloyd S, Eardley I. The implementation
of European Association of Urology guidelines in the management
of acute epididymo-orchitis. Ann R Coll Surg Engl. 2007 Nov.
89(8):799-803.
O Smith et al. Bacterial Infections in Genitourinary Tract in General
Urology 18th. McGraw Hill 2013. Chapter 14. P.216
O Wein AJ, et al. Campbell-Walsh Urology, 11 th ed. Philadelphia :
Elsevier Saunders;2016.329 – 332.