Orchitis and treatmant

Orchitis and treatmant

Orchitis and treatmant

Orchitis is an acute inflammatory reaction of the testis secondary to infection. Most cases are associated with a viral mumps infection; however, other viruses and bacteria can cause orchitis

• Orchitis is characterized by testicular pain and swelling.
• The course is variable and ranges from mild discomfort to severe pain.
• Associated systemic symptoms

  • Fatigue
  • Malaise
  • Myalgias
  • Fever and chills
  • Nausea
  • Headache
• Mumps orchitis follows the development of parotitis by 4-7 days.
• Obtain a sexual history, when appropriate

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Emergency Department Care

• Supportive treatment

  • Bed rest
  • Hot or cold packs for analgesia
  • Scrotal elevation
• Most importantly, the ED physician must rule out testicular torsion, as the two syndromes often present with similar symptoms.^[5]
• Second, the ED physician should consider epididymo-orchitis and, if highly suspected, treat appropriately
   

  Medication Summary

  No medications are indicated for the treatment of viral orchitis.
  Bacterial orchitis or epididymo-orchitis requires appropriate antibiotic coverage for suspected infectious agents. In patients with a bacterial etiology who are younger than 35 years and sexually active, antibiotic coverage for sexually transmitted pathogens (particularly gonorrhea and chlamydia) with ceftriaxone^[6] and either doxycycline^[6] or azithromycin is appropriate. Fluoroquinolones are no longer recommended by the Centers for Disease Control and Prevention (CDC) for treatment of gonorrhea because of resistance. For more information see, CDC updated gonococcal treatment recommendations (April 2007).
  Patients older than 35 years with bacterial etiology require additional coverage for other gram-negative bacteria with a fluoroquinolone or TMP-SMX. Other appropriate medications include analgesics or antiemetics, as needed
  
  

  Further Outpatient Care

  • Supportive therapy

    • Bed rest
    • Scrotal support
    • Analgesics
    • Hot or cold packs for analgesia: Elevation of the scrotum and placement of ice on the affected testis are specific comfort measures that should be recommended to the patient with orchitis. The patient should put a small pillow or a towel between the legs to elevate the scrotum and place ice on the affected testis for 10-15 minutes, 4 times a day, until pain resolves.
  • Patients with a suspected sexually transmitted disease should be referred to their private physician or local health department for HIV testing

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