From the Guidelines
Orchitis should be managed with prompt medical attention, and treatment depends on the underlying cause, with antibiotics being essential for bacterial orchitis, as indicated by the most recent guidelines 1.
Causes and Treatment
Orchitis is an inflammation of one or both testicles, typically caused by infection. The most common causes are viral infections like mumps or bacterial infections that spread from the urinary tract. For viral orchitis, management focuses on symptom relief with pain medications like ibuprofen (600-800mg every 8 hours), scrotal support, ice packs, and rest. For bacterial orchitis, antibiotics are essential, typically ciprofloxacin 500mg twice daily or doxycycline 100mg twice daily for 10-14 days, as these are the most commonly recommended treatments in the literature 1.
Importance of Prompt Treatment
Patients should seek immediate medical attention if experiencing testicular pain and swelling, as prompt treatment helps prevent complications like fertility problems or abscess formation. During recovery, avoiding strenuous activity, wearing supportive underwear, and completing the full course of antibiotics (if prescribed) are important. The condition usually resolves within 1-2 weeks with proper treatment, though severe cases may take longer. Orchitis can sometimes lead to reduced fertility, especially if both testicles are affected, making timely treatment crucial.
Diagnostic Considerations
The evaluation of men for epididymitis and orchitis should include ultrasound (US) of the scrotum, as it is the established first-line imaging modality for acute scrotal disease 1. US can be used to diagnose most scrotal disorders when combined with clinical history and physical examination. High-resolution grayscale and color Doppler US allow prompt and accurate differentiation of scrotal emergencies. The sensitivity and specificity of color Doppler US for the detection of testicular torsion are variable, but it is a valuable tool in the diagnosis of scrotal disorders.
Key Points for Management
- Prompt medical attention is crucial for orchitis to prevent complications.
- Antibiotics are essential for bacterial orchitis.
- Ultrasound (US) of the scrotum is the first-line imaging modality for acute scrotal disease.
- Symptom relief is important for viral orchitis, with pain medications, scrotal support, ice packs, and rest being recommended.
- Completing the full course of antibiotics (if prescribed) and avoiding strenuous activity are important during recovery.
From the FDA Drug Label
Acute epididymo-orchitis caused by N. gonorrhoeae: 100 mg, by mouth, twice a day for at least 10 days. Acute epididymo-orchitis caused by C. trachomatis: 100 mg, by mouth, twice a day for at least 10 days The recommended dose of doxycycline for orchitis (specifically acute epididymo-orchitis) is 100 mg, by mouth, twice a day for at least 10 days 2.
- The treatment duration is at least 10 days.
- The dosage is the same for orchitis caused by N. gonorrhoeae or C. trachomatis.
From the Research
Definition and Causes of Orchitis
- Orchitis is an inflammation of the testis, often caused by bacterial or viral infections 3, 4, 5.
- The most common causes of orchitis are sexually transmitted infections (STIs) such as Chlamydia trachomatis and Neisseria gonorrhoeae in younger men, and urinary tract pathogens such as E. coli in older men 3, 4, 5.
Symptoms and Diagnosis of Orchitis
- Symptoms of orchitis include testicular pain and swelling, which can be accompanied by fever and urinary symptoms such as dysuria and urinary frequency 3, 4, 5.
- Physical examination of a patient with orchitis typically reveals a swollen and tender testis or epididymis, with the testis in an anatomically normal position 3, 4, 5.
- Laboratory studies, including urethral Gram stain, urinalysis and culture, and polymerase chain reaction assay for C. trachomatis and N. gonorrhoeae, can help guide therapy 4.
Treatment of Orchitis
- Treatment of orchitis depends on the underlying cause, with antibiotics such as ceftriaxone and doxycycline recommended for STIs, and ofloxacin or levofloxacin recommended for urinary tract pathogens 3, 4, 5.
- In some cases, metronidazole may be added to the treatment regimen to provide broader anaerobic coverage 6.
- It is essential to differentiate orchitis from testicular torsion, a surgical emergency that requires immediate attention 3, 4, 5.