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Orchitis has a variable onset and ranges from mildly uncomfortable to severely painful. It is most frequently a complication of epididymitis, but isolated orchitis without epididymitis can be caused by mumps infection and, more rarely, other viruses. Mumps orchitis occurs 4 to 7 days after parotid symptoms with testicular pain and swelling. It is unilateral 70% of the time with a contralateral infection developing later 30% of the time. The testicle is swollen and tender, sparing the epididymis. The overlying scrotal skin can be edematous and erythematous. Constitutional symptoms of malaise, headache, myalgias, and fever are common.
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Management and Disposition
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Supportive care with analgesics, hot or cold packs, and scrotal elevation is sufficient for mumps orchitis. Orchitis in the context of epididymo-orchitis is treated the same as epididymitis. Obtain ultrasound to rule out testicular torsion.
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An enlarged, tender epididymis or boggy, tender prostate supports bacterial epididymo-orchitis and is treated the same as epididymitis.
Preceding or concurrent parotid swelling supports mumps orchitis.
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