Treatment for Viral Orchitis
Viral orchitis is managed with supportive care only—there is no specific antiviral treatment indicated, and the condition typically resolves spontaneously. 1, 2
Supportive Management
The cornerstone of treatment consists of conservative measures until symptoms resolve:
- Bed rest, scrotal elevation, and analgesics should be provided until fever and local inflammation subside 1
- NSAIDs or acetaminophen for pain control and reduction of inflammation (general medical practice)
- Ice packs applied to the scrotum may provide additional symptomatic relief (general medical practice)
- Scrotal support with athletic supporter or tight-fitting underwear helps reduce discomfort 1
Diagnostic Confirmation
Before committing to supportive care alone, viral etiology must be confirmed:
- Ultrasound is essential to rule out testicular torsion (a surgical emergency) and to confirm the diagnosis of orchitis 1
- Viral serology (IgM or acute/convalescent IgG) can confirm viral etiology 1
- Common viral causes include mumps virus (most frequent), Coxsackie virus, rubella virus, Epstein-Barr virus, and varicella zoster virus 1, 3
Critical Pitfalls to Avoid
Do not empirically treat with antibiotics if viral orchitis is confirmed, as this provides no benefit and contributes to antimicrobial resistance. However, if bacterial etiology cannot be excluded:
- For men <35 years: Consider ceftriaxone 250 mg IM once PLUS doxycycline 100 mg orally twice daily for 10 days to cover sexually transmitted pathogens (N. gonorrhoeae, C. trachomatis) 1
- For men ≥35 years: Consider ofloxacin 300 mg orally twice daily for 10 days OR levofloxacin 500 mg orally once daily for 10 days to cover enteric organisms 1
Follow-Up and Monitoring
- Reevaluate within 3 days if no improvement occurs—this suggests alternative diagnosis or complications 1
- Persistent swelling after symptom resolution requires comprehensive evaluation to rule out testicular tumor, abscess, infarction, testicular cancer, tuberculosis, or fungal infection 1
- Viral orchitis can mimic testicular neoplasia on imaging and clinical examination, potentially leading to unnecessary orchiectomy 4, 5
- Observation with serial ultrasounds is appropriate for bilateral testicular masses after confirmed viral infection, as spontaneous resolution typically occurs 5
Prognosis
- Most patients recover completely with supportive care alone 4
- Mumps orchitis carries the highest risk of complications, including potential impact on fertility, though sterility is rare 6, 3
- Blood-borne dissemination is the typical route for viral orchitis, unlike bacterial epididymo-orchitis which ascends retrograde 2