Epididymitis and Orchitis

Epididymitis is a collection of tissue just behind the testicle. Epididymitis may have an infectious or inflammation. Most commonly, epididymitis occurs from the reflux of infected urine or from sexually acquired disease caused by gonococci and Chlamydia . This distinction is important because different antiobiotics are needed for the different causes. Occasionally, epididymitis develops after excessive straining or lifting and the reflux of urine into the vas deferens, which causes a chemical epididymitis; this usually resolves promptly. Any non–sexually active child, especially a prepubertal child who develops epididymitis, should be evaluated for a urinary tract abnormality.

Patients with mild symptoms of epididymitis may be treated with oral antibiotics on an outpatient basis. Because of the potential for progressive, chronic epididymal injury, patients with severe epididymitis and patients who are very young should be treated with intravenous antibiotics. Pain and tenderness commonly resolve within 72 hours; however, swelling may persist for weeks.

Orchitis, the term for inflammation of the testicle, is uncommon in infants and young children. Most cases are associated with a viral infection, including mumps. The testis is tender, and the scrotal skin is usually red and swollen. Urinalysis is normal, but the white blood cell count may be elevated. The treatment includes bed rest and observation. In most cases, testicular function is normal. Young adults with mumps orchitis may be at risk for decreased fertility.