Orchitis has a variable onset and ranges from mildly uncomfortable to severely painful. It is most frequently a complication of epididymitis, but isolated orchitis without epididymitis can be caused by mumps infection and, more rarely, other viruses. Mumps orchitis occurs 4 to 7 days after parotid symptoms with testicular pain and swelling. It is unilateral 70% of the time with a contralateral infection developing later 30% of the time. The testicle is swollen and tender, sparing the epididymis. The overlying scrotal skin can be edematous and erythematous. Constitutional symptoms of malaise, headache, myalgias, and fever are common.
Orchitis. Unilateral testicular pain, swelling, scrotal erythema, and edema are seen in this patient with parotitis. (Photo contributor: Lawrence B. Stack, MD.)
Management and Disposition
Supportive care with analgesics, hot or cold packs, and scrotal elevation is sufficient for mumps orchitis. Orchitis in the context of epididymo-orchitis is treated the same as epididymitis. Obtain ultrasound to rule out testicular torsion.
An enlarged, tender epididymis or boggy, tender prostate supports bacterial epididymo-orchitis and is treated the same as epididymitis.
Preceding or concurrent parotid swelling supports mumps orchitis.
Orchitis. Swelling and erythema of the right hemiscrotum in a patient with orchitis. (Photo contributor: David Effron, MD.)