Causes |
- Bacterial Infections: Often secondary to UTIs, common organisms include E. coli, Klebsiella, and Proteus.
- Viral Infections: Mumps virus post-infection.
- Urinary Reflux: Retrograde flow of urine into the vas deferens due to anatomical issues (e.g., posterior urethral valves).
- Trauma: Direct trauma to the scrotum.
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- Viral Infections: Most commonly due to mumps virus, particularly in boys post-mumps infection.
- Bacterial Infections: Secondary to epididymitis, or from sexually transmitted infections (e.g., Chlamydia, Gonorrhea in adolescents).
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Clinical Features |
- Gradual onset of scrotal pain and swelling.
- Redness, tenderness, and warmth over the epididymis.
- Pain may radiate to the groin or lower abdomen.
- Associated with fever and dysuria if related to UTI.
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- Sudden onset of testicular pain and swelling.
- Tenderness and redness over the affected testicle.
- Fever, malaise, and flu-like symptoms (especially in viral orchitis).
- May follow mumps infection or coexist with epididymitis (epididymo-orchitis).
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Tests |
- Urinalysis: To detect infection (leukocytes, nitrites).
- Urine Culture: Identifies bacterial organisms.
- Scrotal Ultrasound: Shows epididymal enlargement, increased blood flow, or abscess.
- Blood Tests: CBC to check for elevated WBC count.
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- Scrotal Ultrasound: Helps differentiate between orchitis and testicular torsion, assesses complications (e.g., abscess).
- Urine/STI Testing: Urine culture, urethral swabs for STI testing in adolescents.
- Viral Titers: Mumps IgM serology to confirm mumps orchitis.
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Management |
- Antibiotics: Empirical antibiotics (e.g., ceftriaxone, amoxicillin-clavulanate), adjusted based on culture results.
- Supportive Care: NSAIDs for pain, scrotal elevation, and bed rest.
- Hydration: Ensure adequate fluid intake.
- Surgery: Rare, unless abscess formation or persistent symptoms occur.
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- Antibiotics: If bacterial cause suspected, appropriate antibiotics (e.g., ceftriaxone, doxycycline for STI-related cases).
- Supportive Care: NSAIDs, scrotal support, and ice packs to reduce swelling.
- Mumps Orchitis: Managed with supportive care, no specific antiviral therapy.
- Follow-Up: Monitor for testicular atrophy or abscess formation.
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