Orchitis is inflammation of the testis, most often from bacteria spreading from epididymitis or from the mumps virus. Mumps orchitis appears a few days after parotid swelling, mainly in unvaccinated adolescent boys and men.
Key symptoms
- Testicular pain and swelling, often on one side
- Fever, tiredness and muscle aches
- Recent parotid swelling (mumps)
- Burning urination or discharge with bacterial causes
What you find on exam
- Swollen, tender testis with red scrotal skin
- Tender epididymis in epididymo-orchitis
- Normal cremasteric reflex
- Check the parotid glands
Tests
- Scrotal Doppler ultrasound: more blood flow, rules out torsion
- Urinalysis, urine culture and NAAT for chlamydia and gonorrhea
- Mumps PCR or serology when suspected
- Blood count if fever is high
Treatment basics
- Viral: rest, scrotal support, ice and NSAIDs
- Bacterial: antibiotics based on age and STI risk, as for epididymitis
- Isolation for mumps and a check of contacts' vaccination
- Follow-up for testicular shrinkage or fertility concerns
Red flags
- Sudden severe pain with absent cremasteric reflex (torsion)
- Abscess or testicular infarction on ultrasound
- Signs of sepsis
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.