Orchitis also is known as inflammation of testis occurs due to raised inflammatory markers at the local site in the scrotal sac. There are symptoms of inflammation in the patient that is fever, pain, redness around the scrotum, swelling of the scrotal sac, etc. It occurs because of the antibodies which were formed against the mumps virus also attacks the epithelium lining of the testis. It starts an inflammatory process at that site where the damage is done by the antibody.
How To Diagnose Orchitis?
The diagnosis for orchitis is to be made carefully even though the symptoms are evident for it. A few of the differential diagnoses can be kept like epididymo-orchitis, torsion of testis, inguinal hernia, hydrocele, varicocele, etc. These all are the conditions in which there is swelling of the testis but not all of these results in pain, fever and other inflammatory signs.
Acutely presenting pain within a few hours usually points towards the diagnosis of torsion of testis. A positive illumination test tends to show the diagnosis of hydrocele. Increase in the swelling on coughing or Valsalva maneuver points for the diagnosis of inguinal hernia. It can also be relocated or regressed by the finger into the abdominal cavity. On examination, if there are widespread blue markings seen on the scrotal skin it points to what the diagnosis of varicocele.
The absence of all such features and negative elimination tests along with the presence of signs of inflammation helps in the diagnosis making of orchitis. Color Doppler study can be done to differentiate between orchitis and epididymo-orchitis. For the confirmation of paramyxovirus infection, serum immunofluorescence antibody testing is done which can detect the presence of antibodies against the paramyxovirus antigen.(1)
What Is The Best Medicine For Orchitis?
Treatment of the orchitis is based upon the causative organism. If the causative organism is the mumps virus that belongs to the paramyxovirus group then there is only symptomatic treatment given. Antipyretics like paracetamol are given to relieve the fever, analgesic like diclofenac is given to relieve the pain, scrotal support in the form of bandage below the scrotal sac is given to reduce the swelling and provide the support to the testis. Adequate hydration is very important to fight the inflammatory response. Cold sponging of the scrotal sac could be done to reduce the inflammation but it should not be done by the ice directly. Instead, ice should be covered by a cloth and then should be used for sponging.
If the orchitis is caused due to a bacterial infection, then the antibiotics are prescribed to counter the infection as well as the inflammatory process. Cefixime which belongs to an oral group of third-generation cephalosporins is used for escherichia coli. Azithromycin which is a macrolide is used for the treatment of chlamydia as well as Neisseria infection. If the condition has worsened or the presentation is late then intravenous antibiotics can be used. Third-generation cephalosporins like ceftriaxone are very effective in such cases. The doses and the period of the treatment depend upon the severity of the condition. It can vary from 3 to 10 days and from once a day dosing to thrice a day dosing.
Conclusion
The diagnosis of orchitis is relatively easy if history taking and clinical examination are done very carefully in a systematic manner and the differential diagnosis is ruled out. Colour Doppler study and serum antibody testing can be used for the confirmation of the diagnosis of orchitis. Treatment for orchitis depends upon the causative organism and the severity of the condition. If the condition is mild and the presentation of the patient is early, then only the symptomatic treatment is preferred. But if the patient presents late and complications have already occurred or started to occur then the treatment regime should be rigorous. Antibiotics should be combined to prevent superadded bacterial infection.
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