What are the common causes of orchitis. How is orchitis diagnosed. What are the typical symptoms of orchitis. How is orchitis treated. Can orchitis lead to complications. Who is at risk for developing orchitis. How can orchitis be prevented.

Understanding Orchitis: An Overview of Testicular Inflammation

Orchitis is a medical condition characterized by inflammation of one or both testicles. While it can occur in isolation, it is more commonly accompanied by inflammation of the epididymis, a condition known as epididymo-orchitis. The condition can be acute, presenting with sudden and severe symptoms, or chronic, developing gradually over time.

The testicles, oval-shaped male reproductive organs located in the scrotum, play a crucial role in producing sperm and male sex hormones. When inflammation occurs, it can significantly impact their function and cause considerable discomfort.

Key Facts About Orchitis:

• Orchitis can affect one or both testicles
• It is often associated with epididymitis
• The condition can be caused by viral or bacterial infections
• Symptoms typically include testicular pain, swelling, and fever
• Proper diagnosis and treatment are essential to prevent complications

Causes and Risk Factors of Orchitis

Orchitis can be caused by various factors, with infections being the most common culprits. Understanding these causes and associated risk factors is crucial for prevention and early intervention.

Viral Causes:

• Mumps virus (most common cause of isolated orchitis)
• Rubella virus
• Coxsackievirus
• Varicella-zoster virus
• Echovirus
• Cytomegalovirus

Bacterial Causes:

• Escherichia coli
• Klebsiella pneumoniae
• Pseudomonas aeruginosa
• Staphylococcus species
• Streptococcus species
• Neisseria gonorrhoeae
• Chlamydia trachomatis
• Treponema pallidum

In immunocompromised patients, opportunistic pathogens such as Mycobacterium avium complex, Cryptococcus neoformans, and Toxoplasma gondii may also cause orchitis.

Risk Factors:

1. History of epididymitis
2. Unprotected sexual activity
3. Multiple sexual partners
4. Long-term use of urinary catheters
5. Bladder outlet obstruction
6. Structural abnormalities of the urinary tract
7. Lack of MMR vaccination

Is there a link between orchitis and sexually transmitted infections. Yes, sexually transmitted infections (STIs) can indeed lead to orchitis. Pathogens such as Neisseria gonorrhoeae and Chlamydia trachomatis, which are commonly associated with STIs, can cause inflammation of the testicles. This underscores the importance of practicing safe sex and getting regular STI screenings for sexually active individuals.

Clinical Presentation and Diagnosis of Orchitis

Recognizing the symptoms of orchitis is crucial for timely diagnosis and treatment. The clinical presentation can vary from mild discomfort to severe pain and systemic symptoms.

Common Symptoms:

• Acute onset of testicular pain (usually unilateral)
• Testicular swelling and tenderness
• Scrotal erythema and edema
• Fever and chills
• Fatigue and malaise
• Nausea and vomiting (in severe cases)

How is orchitis diagnosed. The diagnosis of orchitis primarily relies on a thorough medical history and physical examination. During the physical exam, the healthcare provider will assess:

• Testicular size and consistency
• Presence of scrotal swelling or redness
• Tenderness on palpation
• Cremasteric reflex (which remains normal in orchitis)

Additional diagnostic tests may include:

• Urinalysis and urine culture
• Blood tests for infection markers
• Scrotal ultrasound to visualize testicular structure and blood flow
• Sexually transmitted infection screening

In cases of suspected mumps orchitis, salivary gland examination and serological tests may be necessary.

Treatment Approaches for Orchitis

The management of orchitis aims to alleviate symptoms, treat the underlying cause, and prevent complications. The treatment approach may vary depending on the etiology and severity of the condition.

Conservative Management:

• Rest and scrotal support
• Application of cold packs to reduce swelling
• Over-the-counter pain relievers (e.g., ibuprofen, acetaminophen)
• Elevation of the scrotum to improve circulation

Pharmacological Interventions:

• Antibiotics for bacterial orchitis (e.g., ceftriaxone, doxycycline)
• Antiviral medications for viral orchitis (limited efficacy)
• Analgesics for pain management
• Anti-inflammatory drugs to reduce swelling

What is the typical duration of antibiotic treatment for bacterial orchitis. The standard course of antibiotic treatment for bacterial orchitis usually lasts 10 to 14 days. However, the exact duration may vary depending on the causative organism and the patient’s response to treatment. It’s crucial to complete the full course of antibiotics as prescribed, even if symptoms improve, to ensure complete eradication of the infection and prevent recurrence.

Potential Complications and Long-term Effects of Orchitis

While most cases of orchitis resolve without significant long-term consequences, some patients may experience complications. Understanding these potential outcomes is essential for patient education and follow-up care.

Possible Complications:

• Testicular atrophy
• Infertility or reduced fertility
• Chronic testicular pain
• Abscess formation
• Sepsis (in severe cases)

Can orchitis lead to permanent infertility. While orchitis can potentially affect fertility, permanent infertility is relatively rare. The risk is higher in cases of bilateral orchitis, particularly when caused by mumps. Approximately 30-50% of men with bilateral mumps orchitis may experience some degree of testicular atrophy, which can impact sperm production. However, complete infertility occurs in only about 13% of these cases. Prompt treatment and appropriate follow-up can help minimize the risk of long-term fertility issues.

Long-term Effects:

The long-term effects of orchitis can vary depending on the severity and duration of the inflammation. Some patients may experience:

• Persistent testicular pain or discomfort
• Changes in testicular size or consistency
• Altered hormonal function (in rare cases)
• Psychological impact on sexual health and self-image

Regular follow-up with a urologist or andrologist is recommended to monitor for any long-term effects and address potential fertility concerns.

Prevention Strategies and Lifestyle Modifications

Preventing orchitis involves a combination of lifestyle modifications, good hygiene practices, and appropriate medical interventions. By understanding and implementing these preventive measures, individuals can significantly reduce their risk of developing this condition.

Key Prevention Strategies:

1. Vaccination: Ensure up-to-date MMR (Measles, Mumps, Rubella) vaccination
2. Safe sex practices: Use condoms and limit sexual partners
3. Regular STI screening for sexually active individuals
4. Proper hygiene, especially after using the bathroom
5. Prompt treatment of urinary tract infections
6. Avoiding prolonged sitting or bicycle riding
7. Wearing supportive underwear during physical activities

How effective is the MMR vaccine in preventing mumps orchitis. The MMR vaccine is highly effective in preventing mumps and its complications, including orchitis. Studies have shown that the vaccine is approximately 88% effective in preventing mumps after two doses. While breakthrough infections can occur, vaccinated individuals who do contract mumps are less likely to develop complications such as orchitis. The widespread use of the MMR vaccine has significantly reduced the incidence of mumps orchitis in many countries.

Orchitis in Special Populations

While orchitis can affect males of any age, certain populations may be at higher risk or require special considerations in terms of diagnosis and management.

Orchitis in Adolescents:

Adolescent males are particularly susceptible to viral orchitis, especially due to mumps. Key points include:

• Higher risk if not fully vaccinated against mumps
• May experience more severe symptoms
• Potential impact on future fertility is a significant concern
• Psychological support may be necessary

Orchitis in Immunocompromised Patients:

Individuals with weakened immune systems are at increased risk of developing orchitis and may experience more severe or atypical presentations. Considerations include:

• Higher risk of opportunistic infections
• May require more aggressive treatment approaches
• Close monitoring for complications is essential
• Potential drug interactions with existing medications

How should orchitis be managed in HIV-positive patients. Managing orchitis in HIV-positive individuals requires a comprehensive approach:

1. Thorough evaluation for opportunistic pathogens
2. Consideration of potential drug interactions with antiretroviral therapy
3. More frequent follow-up to monitor response to treatment
4. Adjustment of antibiotic regimens based on immune status
5. Collaboration between infectious disease specialists and urologists

The goal is to effectively treat the orchitis while maintaining optimal management of the underlying HIV infection.

Emerging Research and Future Directions in Orchitis Management

As medical science advances, new insights into the pathophysiology, diagnosis, and treatment of orchitis continue to emerge. These developments hold promise for improved patient outcomes and more targeted therapeutic approaches.

Current Research Focus Areas:

• Genetic factors influencing susceptibility to orchitis
• Novel diagnostic techniques for rapid pathogen identification
• Immunomodulatory therapies for autoimmune orchitis
• Potential role of probiotics in preventing recurrent infections
• Long-term fertility preservation strategies for orchitis patients

What are some promising new treatments on the horizon for orchitis. While research is ongoing, several innovative approaches show potential:

1. Targeted antibiotic delivery systems to improve efficacy and reduce side effects
2. Gene therapy techniques to enhance testicular resistance to inflammation
3. Nanotechnology-based diagnostic tools for faster and more accurate pathogen detection
4. Stem cell therapies to promote testicular tissue regeneration after severe inflammation
5. Personalized treatment protocols based on genetic and immunological profiles

These emerging therapies are still in various stages of research and development, but they represent exciting possibilities for the future of orchitis management.

In conclusion, orchitis remains a significant concern in male reproductive health. While current management strategies are generally effective, ongoing research continues to refine our understanding and approach to this condition. By staying informed about the latest developments and maintaining a proactive stance towards prevention and early intervention, healthcare providers and patients can work together to minimize the impact of orchitis on male health and fertility.

Orchitis – StatPearls – NCBI Bookshelf

Continuing Education Activity

Orchitis is the inflammation of the testis and is usually unilateral. Other diseases like mumps or epididymitis often accompany orchitis, isolated orchitis is rare. Diagnosis is generally on history and physical examination. Serious complications are uncommon; however, accurate diagnosis is crucial for efficient management. This activity reviews the evaluation and treatment of orchitis and highlights the role of the interprofessional team in the care of patients with this condition.

Objectives:

• Describe the etiology of orchitis.

• Review the clinical presentation of orchitis.

• Summarize the treatment and management of orchitis.

• Explain the importance of care coordination amongst the interprofessional team to enhance the care of patients with orchitis.

Access free multiple choice questions on this topic.

Introduction

Orchitis is defined as the inflammation of the testicle unilaterally or bilaterally usually caused by viruses and bacteria. Testes are two oval male reproductive organs situated in the scrotum. They are responsible for the production of male sex hormones and sperm. The testis is innervated by the testicular plexus, which contains nerves originating from the renal and aortic plexus. The main arterial supply is by paired testicular artery, arising from the abdominal aorta, which passes via the inguinal canal inside the spermatic cord. Venous drainage is through the pampiniform plexus. As testis are originally retroperitoneal organs, lymphatic drainage is through para-aortic lymph nodes, while superficial inguinal lymph nodes drain the scrotum.

Orchitis can be acute and symptomatic on the presentation or asymptomatic and chronic.[1] Isolated orchitis is rare and is usually accompanied by an infection of the epididymis. The major route for the spread is blood-borne dissemination for isolated orchitis.[2] Ascending infections can also involve testis.

Etiology

Various bacteria and viruses cause orchitis.

• Orchitis in young patients is usually viral, with mumps and rubella being the most common causes. Reports exist of cases of orchitis after the measles, mumps, and rubella (MMR) vaccine.[3]

• Other viruses include coxsackievirus, varicella, echovirus, and cytomegalovirus.

• Bacterial infections of the prostate and urinary tract infection can cause orchitis. Common causes of bacterial orchitis include Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus and Streptococcus species.

• Bacteria that can cause sexually transmitted infections can also cause orchitis in sexually active males. Common organisms are Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum

• Mycobacterium avium complex, Cryptococcus neoformans, Toxoplasma gondii, Haemophilus parainfluenzae, and Candida albicans have been reported to cause orchitis in immunocompromised patients.

There are also reports of orchitis caused by autoimmunity, which can classify as primary and secondary.[4]

Epidemiology

Orchitis alone is very uncommon and is usually accompanied by epididymitis, hence the true incidence is unclear. Current literature also does not suggest any predilection for any race or religion.

Orchitis develops in 14% to 35% of postpubertal patients with mumps. Symptoms develop 4 to 8 days after parotitis but can also occur in the absence of parotitis. Mumps virus is responsible for most of the cases of isolated orchitis.

Pathophysiology

Orchitis is the inflammation of the testis, and isolated acute orchitis is a very rare phenomenon.[5] Orchitis is usually unilateral, and symptoms can vary from mild to severe. Most cases resolve by the end of two weeks. There are two significant differences between orchitis and infections of other male accessory sex organs:

• The primary route of the spread of infection to the testis is blood-borne dissemination. [2]

• Viruses are implicated as significant pathogens.

Common risk factors include a preexisting history of epididymitis, unprotected sexual contact, multiple sexual partners, long-term use of foley catheter, bladder outlet obstruction, structural abnormality, and lack of immunization with MMR vaccination (vaccination reduces the risk of developing orchitis after mumps).[6]

History and Physical

The patient usually presents with acute onset of testicular pain, which may initially involve one testis, and then may spread to include the whole scrotum. The patient may also complain of fever accompanied by malaise, fatigue, and chills.

Examination findings may include testicular enlargement, tenderness, and induration. Scrotal edema and erythema may also be present. The epididymis may also be enlarged if orchitis is accompanied by epididymitis. The cremasteric reflex is normal in affected individuals. Mumps orchitis may present with bilateral parotid enlargement and usually present 4 to 8 days after onset of parotitis.

When evaluating such patients, the clinician should also note various risk factors so that they can receive appropriate management.

Evaluation

Orchitis diagnosis is usually from history and physical findings. Laboratory tests are generally not helpful, but urethral swabs and urine samples may be obtained for routine examination and cultures to rule out urinary tract infection and diagnose sexually transmitted infections as the source.

When assessing patients with acute testicular or scrotal pain, it is imperative to rule out testicular torsion. For such patients, color Doppler ultrasonography of the scrotum is the first choice of investigation.

Ultrasonography findings in patients with mumps orchitis usually subside by the seventh day.[7] Although not typically done, serum immunofluorescence antibody testing is useful to confirm the diagnosis of mumps orchitis.

Treatment / Management

In an emergency, clinicians must distinguish between torsion and inflammation of the testis. Antibiotics are not necessary for viral causes of the disease. Supportive therapies such as bed rest, antipyretics, analgesics, scrotal support, and hot or cold packs for analgesia are advisable.

Antibiotics should start empirically based on the likely pathogens according to age and sexual history.

• If there is suspicion of an enteric bacteria is suspected, then fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin) for 10 to 14 days are the preferred drugs. Trimethoprim-sulfamethoxazole is also an option for these pathogens.

• If there is suspicion of a sexually transmitted pathogen, then treatment should consist of ceftriaxone 250 mg single shot intramuscularly and doxycycline 100 mg twice daily for 10 to 14 days. Azithromycin is also an option in place of doxycycline.

Sexual partners of the patient with sexually transmitted pathogens should receive treatment.[8] The inability to take oral antibiotics, signs of sepsis, and failure of previous outpatient therapy should warrant inpatient therapy.

Differential Diagnosis

Careful evaluation for probable reasons for acute scrotal pain and swelling is essential for the efficient management of the patients. Testicular torsion is the most significant differential as urgent exploration is required.[9] Other differentials include:

Prognosis

Overall, the majority of viral cases and antibiotic-treated cases will resolve without any complications. Most of the patients are treated as outpatients. The swelling and tenderness may persist even after antibiotic therapy but should be significantly improved. In case of persistence, compliance should be checked, and receive further evaluation if required. The decrease in body temperature in the first three days of antibacterial treatment is considered a good prognostic marker.[10] Most cases of mumps orchitis also resolve within ten days.

Complications

Complications are preventable with accurate diagnosis and efficient management of patients.[11] Most patients recover without sequelae; however, there are reports of the following complications:

Rarely in cases of pyogenic orchitis and testicular infarction, an abscess can be formed which requires surgical consultation for management.

Consultations

The majority of cases do not require consultations. In some complicated cases, consultations may be required such as:

• Formation of abscess or infarction of testicle may require surgical consultation.

• Infectious diseases can be consulted in the case of immune-compromised patients.

• Urology should be consulted if there is a suspicion of torsion on presentation.

Deterrence and Patient Education

Prevention revolves primarily in avoiding the risk factors:

•  Vaccination against mumps

•  Safe sex practices to prevent gonorrheal and chlamydial infections

•  Avoid indwelling urinary catheters

•  Surgically correct urinary tract obstructions for eligible patients

All clinical staff should advise patients to take the full course of antibiotics to prevent the emergence of resistance and recurrence.

Pearls and Other Issues

• Samples for blood and urine culture should be taken before starting antibiotic therapy.

• In the case of recurrence, the patient requires evaluation for the preexisting risk factors like bladder outlet obstruction.

• The risk of antibiotic-resistant pathogens increases in patients with indwelling catheters, so in addition to a fluoroquinolone, a third-generation cephalosporin should also be given empirically while waiting for culture reports.[12]

Enhancing Healthcare Team Outcomes

The management of orchitis is usually on an outpatient basis; severe complications are rare. The condition still merits the involvement of an interprofessional healthcare team. However, several measures can help improve the outcomes and prevent the disease.

A study conducted in England and Wales concluded that vaccination with MMR provides significantly greater protection against hospitalization and risk of orchitis in diagnosed cases of mumps.[13] So parents should be educated about the benefits of getting their children vaccinated.

Another study showed that in general practice, patients presenting with symptoms of orchitis do not usually receive testing for sexually transmitted infections. [14] This practice needs to improve as these infections affect not only the individual but also their sexual partners.

In Europe and the U.S.A, the isolates of Escherichia coli are becoming increasingly resistant to ciprofloxacin, which requires finding alternatives with sufficient penetration into testis for efficient and comprehensive management of orchitis.[15] 

Urodynamic studies should only be for patients with suspicion of urinary tract obstruction.[16]

Urology nurses are involved in the administration of treatment, patient education, and reporting back to the team. Pharmacists check medication dosage, interactions, assist the clinician with antimicrobial therapy selection, and also provide patient education. These types of interprofessional team collaboration can improve patient outcomes in cases of orchitis. [Level 5]

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• Comment on this article.

References

1.

Pilatz A, Fijak M, Wagenlehner F, Schuppe HC. [Orchitis]. Urologe A. 2019 Jun;58(6):697-710. [PubMed: 31111192]

2.

Krieger JN. Epididymitis, orchitis, and related conditions. Sex Transm Dis. 1984 Jul-Sep;11(3):173-81. [PubMed: 6390741]

3.

Kanda T, Mochida J, Takada S, Hori Y, Yamaguchi K, Takahashi S. Case of mumps orchitis after vaccination. Int J Urol. 2014 Apr;21(4):426-8. [PubMed: 24164648]

4.

Silva CA, Cocuzza M, Carvalho JF, Bonfá E. Diagnosis and classification of autoimmune orchitis. Autoimmun Rev. 2014 Apr-May;13(4-5):431-4. [PubMed: 24424181]

5.

Ludwig M. Diagnosis and therapy of acute prostatitis, epididymitis and orchitis. Andrologia. 2008 Apr;40(2):76-80. [PubMed: 18336454]

6.

Hahné S, Whelan J, van Binnendijk R, Swaan C, Fanoy E, Boot H, de Melker H. Mumps vaccine effectiveness against orchitis. Emerg Infect Dis. 2012 Jan;18(1):191-3. [PMC free article: PMC3381682] [PubMed: 22260843]

7.

Başekim CC, Kizilkaya E, Pekkafali Z, Baykal KV, Karsli AF. Mumps epididymo-orchitis: sonography and color Doppler sonographic findings. Abdom Imaging. 2000 May-Jun;25(3):322-5. [PubMed: 10823460]

8.

Manavi K, Turner K, Scott GR, Stewart LH. Audit on the management of epididymo-orchitis by the Department of Urology in Edinburgh. Int J STD AIDS. 2005 May;16(5):386-7. [PubMed: 15949072]

9.

Walker NA, Challacombe B. Managing epididymo-orchitis in general practice. Practitioner. 2013 Apr;257(1760):21-5, 2-3. [PubMed: 23724748]

10.

Banyra O, Shulyak A. Acute epididymo-orchitis: staging and treatment. Cent European J Urol. 2012;65(3):139-43. [PMC free article: PMC3921787] [PubMed: 24578950]

11.

Street EJ, Justice ED, Kopa Z, Portman MD, Ross JD, Skerlev M, Wilson JD, Patel R. The 2016 European guideline on the management of epididymo-orchitis. Int J STD AIDS. 2017 Jul;28(8):744-749. [PubMed: 28632112]

12.

Pilatz A, Boecker M, Schuppe HC, Wagenlehner F. [Current Aspects of Epididymo-Orchitis]. Aktuelle Urol. 2016 May;47(3):237-42. [PubMed: 27123660]

13.

Yung CF, Andrews N, Bukasa A, Brown KE, Ramsay M. Mumps complications and effects of mumps vaccination, England and Wales, 2002-2006. Emerg Infect Dis. 2011 Apr;17(4):661-7; quiz 766. [PMC free article: PMC3377415] [PubMed: 21470456]

14.

Nicholson A, Rait G, Murray-Thomas T, Hughes G, Mercer CH, Cassell J. Management of epididymo-orchitis in primary care: results from a large UK primary care database. Br J Gen Pract. 2010 Oct;60(579):e407-22. [PMC free article: PMC2944950] [PubMed: 20883615]

15.

Ryan L, Daly P, Cullen I, Doyle M. Epididymo-orchitis caused by enteric organisms in men > 35 years old: beyond fluoroquinolones. Eur J Clin Microbiol Infect Dis. 2018 Jun;37(6):1001-1008. [PubMed: 29450767]

16.

Ibrahim AA, Refeidi A, El Mekki AA. Etiology and clinical features of acute epididymo-orchitis. Ann Saudi Med. 1996 Mar;16(2):171-4. [PubMed: 17372435]

Disclosure: Chaudhary Ehtsham Azmat declares no relevant financial relationships with ineligible companies.

Disclosure: Pradeep Vaitla declares no relevant financial relationships with ineligible companies.

Orchitis: MedlinePlus Medical Encyclopedia

Orchitis is swelling (inflammation) of one or both of the testicles.

Orchitis may be caused by an infection. Many types of bacteria and viruses can cause this condition.

The most common virus that causes orchitis is mumps. It most often occurs in boys after puberty. Orchitis most often develops 4 to 6 days after the mumps begins.

Orchitis may also occur along with infections of the prostate or epididymis.

Orchitis may be caused by a sexually transmitted infection (STI), such as gonorrhea or chlamydia. The rate of sexually transmitted orchitis or epididymitis is higher in men ages 19 to 35.

Risk factors for sexually transmitted orchitis include:

• High-risk sexual behaviors
• Multiple sexual partners
• Personal history of gonorrhea or another STI
• Sexual partner with a diagnosed STI

Risk factors for orchitis not due to an STI include:

• Being older than age 45
• Long-term use of a Foley catheter
• Not being vaccinated against the mumps virus
• Problems of the urinary tract that were present at birth (congenital)
• Repeated urinary tract infections
• Surgery of the urinary tract (genitourinary surgery)
• BPH (benign prostatic hyperplasia) – enlarged prostate
• Urethral stricture (scarring inside urinary tract that causes narrowing of the passageway)

Symptoms include:

• Pain in the testicle
• Blood in the semen
• Discharge from penis
• Fever
• Groin pain
• Pain with intercourse or ejaculation
• Pain with urination (dysuria)
• Scrotal swelling
• Tender, swollen groin area on affected side
• Tender, swollen, heavy feeling in the testicle

A physical exam may show:

• Enlarged or tender prostate gland
• Tender and enlarged lymph nodes in the groin (inguinal) area on the affected side
• Tender and enlarged testicle on the affected side
• Redness or tenderness of scrotum

Tests may include:

• Complete blood count (CBC)
• Testicular ultrasound
• Tests to screen for chlamydia and gonorrhea (urethral smear)
• Urinalysis
• Urine culture (clean catch) — may need several samples, including initial stream, midstream, and after prostate massage

Treatment may include:

• Antibiotics, if the infection is caused by bacteria. (In the case of gonorrhea or chlamydia, sexual partners must also be treated.)
• Anti-inflammatory medicines.
• Pain medicines.
• Bed rest with the scrotum elevated and ice packs applied to the area.

Getting the right diagnosis and treatment for orchitis caused by bacteria can most often allow the testicle to recover normally.

You will need further testing to rule out testicular cancer if the testicle does not completely return to normal after treatment.

Mumps orchitis has no effective treatment, and the outcome can vary. Men who have had mumps orchitis can become sterile.

Some boys who get orchitis caused by mumps will have shrinking of the testicles (testicular atrophy).

Orchitis may also cause infertility.

Other potential complications include:

• Chronic epididymitis
• Death of testicle tissue (testicular infarction)
• Fistula on the skin of the scrotum (cutaneous scrotal fistula)
• Scrotal abscess

Acute pain in the scrotum or testicles can be caused by twisting of the testicular blood vessels (torsion). This is a medical emergency that requires immediate surgery.

A swollen testicle with little or no pain may be a sign of testicular cancer. If this is the case, you should have a testicular ultrasound.

See your health care provider for an exam if you have testicle problems.

Get emergency medical help if you have sudden pain in the testicle.

Things you can do to prevent the problem include:

• Get vaccinated against mumps.
• Practice safer sex behaviors to decrease your risk for STIs.

Epididymo – orchitis; Testis infection

• Male reproductive anatomy
• Male reproductive system

Mason WH, Gans HA. Mumps. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 275.

McGowan CC. Prostatitis, epididymitis, and orchitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 110.

Pontari M. Inflammatory and pain conditions of the male genitourinary tract: prostatitis and related pain conditions, orchitis, and epididymitis. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 56.

Updated by: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

symptoms, causes and treatment of testicular inflammation in men

Content

• 1 Orchitis – symptoms, causes and treatment of testicular inflammation
  • 1.1 What is orchitis?
  • 1.2 Symptoms of orchitis
  • 1.3 Causes of orchitis
  • 1.4 Inflammation of the testis in children
    • 1.4.1 Symptoms of orchitis in children
    • 1. 4.2 Causes of orchitis in children
    • 1.4.3 Treatment of orchitis in children
  • 1.5 How find orchitis?
    • 1.5.1 Symptoms of orchitis
  • 1.6 Orchitis and pregnancy
    • 1.6.1 Threat turns into reality
    • 1.6.2 How to avoid problems during pregnancy
  • 1.7 Orchitis treatment

  90 005 1.8 Orchitis and its consequences

  • 1.8.1 Effect of orchitis on men’s health
  • 1.8.2 Acute and chronic orchitis
  • 1.8.3 Orchitis prevention
  • 1.9 Orchitis prevention
  • 1.10 Orchitis and sexual activity 90 008
  • 1.11 When should I see a doctor for orchitis?
  • 1.12 Related videos:
  • 1.13 Q&A:
    • • 1.13.0.1 What are the symptoms of orchitis?
      • 1.13.0.2 What are the causes of orchitis?
      • 1.13.0.3 How is orchitis diagnosed?
      • 1.13.0.4 What are the consequences of orchitis?
      • 1.13.0.5 How is orchitis treated?
      • 1. 13.0.6 How can orchitis be prevented?

Orchitis is an inflammation of the testis in men, which can occur due to various causes and has unpleasant symptoms. The article describes the main causes, symptoms and methods of treatment of orchitis to maintain the health of men.

Orchitis is a pathological condition of the male testicle due to inflammation. Such a disease requires immediate treatment, as it can lead to serious complications that will be much more difficult to eliminate.

Symptoms of orchitis in men are also hard to miss. This may be a sudden increase in body temperature, which is accompanied by pain in the area between the abdomen and leg. Swelling and redness of the testicle may also appear, and in more advanced cases, the man may experience erectile dysfunction and genitourinary system functions.

The causes of orchitis can vary from infectious diseases to trauma and circulation disorders. In any case, if necessary, of course, you need to contact a doctor who will find out the cause and offer the necessary treatment.

The treatment of orchitis looks different in each individual case, but we always emphasize that the sooner you seek medical help, the greater the chances of a full rehabilitation. By the way, even minor symptoms are a signal to see a doctor!

What is orchitis?

Orchitis is an inflammatory process that occurs in the testicles of men. It may occur as a result of an infection or for other reasons. Orchitis can be unilateral or bilateral, and is accompanied by pain, swelling, redness, and fever in the testicles.

Orchitis treatment depends on its cause. If the inflammation is caused by an infection, then antibiotics should be taken. If orchitis is caused by a viral infection, then symptomatic therapy and antiviral drugs are needed. In some cases, hospitalization may be required.

To prevent orchitis, it is important to practice good hygiene, use condoms, get a mumps vaccination and see a doctor at the first sign of inflammation.

Symptoms of orchitis

Orchitis is a disease that is accompanied by inflammation of the testicles in men. It may be acute or chronic. Symptoms of orchitis depend on the type of disease and may present as follows:

• Pain in the testicular region, which may extend to the entire scrotum
• Swelling and redness of the testicle
• Fever
• General deterioration of well-being
• Headaches and dizziness

In the case of acute orchitis, the symptoms develop quickly and can reach a high intensity. Chronic orchitis, on the contrary, manifests itself slowly and can proceed without pronounced symptoms. In any case, when the first signs of orchitis appear, you should consult a doctor and start treatment as early as possible.

Causes of orchitis

Orchitis is an inflammation of one or both testicles in men. Orchitis can be caused by an infection caused by bacteria, viruses, or fungi. The most common triggers are viruses, such as the mumps virus, which causes mumps, and herpes viruses.

Other causes of orchitis may be allergies, immunodeficiencies, or certain medications. Some rare forms of testicular cancer can also lead to orchitis.

Regardless of the cause, orchitis can lead to serious complications, so it is important to see a doctor at the first sign of testicular inflammation.

Inflammation of the testicle in children

Symptoms of orchitis in children

Orchitis is manifested by inflammation of one or both testicles. In children, symptoms of orchitis may include testicular pain, swelling, and redness of the scrotum. The child’s body temperature may also rise.

Causes of orchitis in children

Orchitis in children can result from infectious diseases such as measles, chickenpox and mumps. Also, orchitis can be associated with testicular injury.

Treatment of orchitis in children

Treatment of orchitis in children includes antibiotics for infection and anti-inflammatory drugs to reduce pain and swelling. If the testicle is injured, surgery may be required.

How to detect orchitis?

Orchitis is a condition of testicular inflammation in men that can cause a variety of symptoms. Some of them can be very painful and require immediate medical attention. How do you know if you have orchitis?

Symptoms of orchitis

1. Swelling and redness of the testicles
2. Pain and discomfort in the testicles and scrotum
3. Fever
4. Dizziness or weakness stay within a few days.

If you notice one or more of these symptoms, you should contact your doctor immediately. The sooner you receive treatment, the higher the chances of a full recovery and avoid complications.

Orchitis and pregnancy

The threat becomes reality

Orchitis, an inflammation of the testis in men, can lead to a serious problem during pregnancy. In cases where the disease is not diagnosed or treated, orchitis can cause many problems for a couple trying to conceive.

Complications can be much worse than they seem at first glance . Chronic orchitis can lead to impaired testicular function, which can lead to low sperm levels and reduced sperm quality. In addition, orchitis can cause diseases that are dangerous for both mother and child – for example, chicken pox or cytomegalovirus infection. As a general rule, treatment for orchitis should be started as early as possible to minimize health risks to the partner and unborn child.

How to avoid problems during pregnancy

The best way to avoid problems associated with orchitis is prevention . Friendly games, sporting events, and other events that can cause testicular injury should be avoided. It is also necessary to monitor hygiene and consult a doctor at the first sign of illness. It is important to remember that orchitis can be caused not only by an infection, but also by an autoimmune reaction, so it is important not to delay contacting a specialist. In addition, it is preferable that therapy be carried out before the start of pregnancy, so a couple planning a child should pay attention to their health and undergo a medical examination beforehand.

Treatment of orchitis

Treatment of an inflamed testicle must begin immediately to prevent complications. Your doctor may recommend starting treatment with pain medication to reduce pain and inflammation in the testicular area.

If the orchitis is caused by a bacterial infection, antibiotics are needed. It is important to accurately determine the cause of the inflammation in order to prescribe the appropriate medication.

In some cases, hospitalization may be required, especially if the infection is very advanced or causes dangerous complications.

With orchitis caused by a virus, treatment may take time, but in most cases it ends with a full recovery.

For any symptoms of orchitis, it is necessary to consult a specialist in order to prescribe effective treatment and prevent possible complications.

Orchitis and its consequences

The effect of orchitis on men’s health

Orchitis, an inflammation of the testis, can seriously affect men’s health. Despite the fact that most cases of orchitis are caused by a virus, the disease can cause not only severe pain and discomfort in the testicles, but also lead to impotence and infertility.

Impotence and infertility are the most dangerous consequences of orchitis. Inflammation of the testicle can lead to disruption of spermatogenesis and a decrease in the number of spermatozoa in seminal fluid, which in turn can lead to infertility. In addition, inflammation of the testicle can damage the nerve fibers, which leads to erectile dysfunction and the development of impotence.

Acute and chronic orchitis

Orchitis can manifest itself as an acute form, which is characterized by sharp pain in the testicle, swelling and redness of the testicle and its appendages. An increased body temperature and general weakness are also possible. The chronic form of orchitis develops when the acute form has not been treated correctly or has not been cured at all. Chronic orchitis is manifested by milder symptoms, but can last for months or even years, so treatment in this case should be longer and more thorough.

Orchitis Prevention

• Keep your genitals clean and wash them regularly.
• Avoid contact with people who have orchitis or other conditions that can cause orchitis.
• See your doctor to test for antibodies to the virus that causes orchitis and get the necessary vaccinations.
• At the first sign of orchitis, contact your doctor to start treatment immediately.

Orchitis prophylaxis

Orchitis is a serious disease that can lead to undesirable consequences. To protect yourself from this disease, you need to follow the recommendations for prevention.

• Maintain hygiene. Wash your genitals regularly with warm water and soap. Avoid wearing tight underwear that can chafe your skin.
• Strengthen your immune system. Proper nutrition, healthy sleep, moderate exercise, and not smoking can help boost the immune system and protect against many infections, including orchitis.
• Avoid injury. Try to avoid strong blows to the scrotum and testicles, wear durable and comfortable protection when participating in sports activities.
• Avoid contact with infections. Avoid contact with sick people and wash your hands thoroughly before eating, after visiting public places and after contact with infected objects.

By following simple rules for the prevention of orchitis, you can reduce the risk of developing this disease. If you experience any symptoms of testicular inflammation, see a medical professional for diagnosis and treatment.

Orchitis and sexual activity

Since orchitis is an inflammation of the testicle in a man, it can negatively affect his sexual activity. Orchitis can cause pain and discomfort in the testicles, which can make it difficult to get an erection. In addition, inflammation can lead to decreased libido and sperm concentration, which can lead to infertility.

In the event of orchitis, a doctor should be consulted immediately. Medications and movement, such as rest, ice, and a secure testicle ring, can help relieve symptoms and prevent chronic problems.

When should I see a doctor for orchitis?

Orchitis is a serious problem that can lead to many complications, but how do you know when to go to the doctor? The most important and obvious symptom of testicular inflammation is swelling and pain in the testicle. If they do not go away within a few days, do not disappear with the use of general analgesics, you should consult a specialist.

Also, if you have a temperature above 38 degrees, then this is also a sign of orchitis. You should not wait for it to decrease by itself, you need to go to the doctor.

If you notice any changes in the skin of the testicles or even see visible deformities and knots, contact a specialist immediately.

If the testicle hurts or even bleeds when touched, this is also a very alarming symptom, in which case it is necessary to consult a doctor as soon as possible.

All symptoms of orchitis must be carefully monitored and even if you have only mild pain in the testicles, it is better to go to the urologist and get an examination. In many cases, the earlier the disease is diagnosed, the greater the chance of successful treatment.

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Q&A:

What are the symptoms of orchitis?

Orchitis is manifested by pain and swelling of the testicles, increased body temperature, general malaise. It is also possible the appearance of a bloody secret from the genitourinary system and a decrease in the level of sex hormones.

What causes orchitis?

Orchitis can be caused by infectious diseases (eg, mumps), trauma, impaired blood supply to the testicle, and autoimmune and allergic reactions.

How is orchitis diagnosed?

To diagnose orchitis, the doctor conducts an examination of the patient, communication and a number of laboratory and instrumental studies, including ultrasound of the testicles.

What are the consequences of orchitis?

The consequences of orchitis may vary depending on the cause of the disease and the time of initiation of treatment. In the most severe cases, infertility can develop, and complications of the cardiovascular and genitourinary systems are also possible. In this regard, it is important to consult a doctor in a timely manner and treat orchitis.

How is orchitis treated?

Orchitis is treated according to its cause. The treatment is based on antibacterial, antiviral, and hormonal drugs. Symptomatic procedures are also carried out – anesthesia, antipyrine and compresses.

How can orchitis be prevented?

Orchitis prevention is based on personal hygiene, strengthening the body’s immunity, avoiding casual relationships and using contraception, as well as timely contacting a doctor at the first symptoms of the disease.

Diseases of the testicles. characteristic symptoms. Causes

Diseases of the testicles (testicles) are not so common in men. However, all of them are accompanied by extremely unpleasant sensations, negatively affect sexual life and reproductive function. In some cases, they can be life-threatening. Consider some of the most common testicular diseases.

Orchitis

Orchitis is an inflammation of the testis. The disease is characterized by very strong pain sensations, they occur in the scrotum and give to the groin. The disease practically does not occur as an independent disease, but is a consequence of other pathologies. For example, in 5% of cases, the disease develops as a result of an injury, so men need to be very careful when playing, say, football, cycling, etc.

Symptoms of orchitis (pain, inflammation, redness of the scrotum, and high fever) may last up to two to three weeks and then disappear on their own. However, this often does not mean that the disease has not disappeared. The testicular tissue begins to produce less sperm, thus, the transferred orchitis has an extremely negative effect on fertility, that is, the ability to fertilize. With improper treatment, orchitis often becomes chronic.

Epididymitis

Epididymitis is an inflammation of the epididymis. The disease is also characterized by high fever, sharp pain in the scrotum, swelling. The disease develops for the following reasons:

• infection;
• complications of urethritis and prostatitis;
• complication of mumps;
• difficulty urinating;
• past injuries, blows;
• tuberculosis.

Symptoms are characterized by:

• scrotal pain and swelling;
• fever, chills and fever;
• swollen groin;
• pain during urination and ejaculation;
• the appearance of blood in the semen;
• purulent discharge from the urethra.

Hydrocele

Hydrocele is otherwise called hydrocele – the accumulation of fluid between the membranes of the testicle. It occurs in 1% of men. Dropsy can be congenital, which is why this disease occurs in 10% of all newborn boys. This condition is not pathological – as the child grows, the pathology of testicular development gradually disappears.

However, hydrocele is often acquired. It develops as a result of chronic inflammation of the testicle, trauma, as well as as a result of cardiovascular insufficiency, cancer. This leads to the fact that the tissues of the testicle become denser, it increases in size, and as a result, fluid accumulates in the tissues. Treatment of dropsy consists in wearing a suspensoria – a special supporting bandage. If treatment fails, surgery is indicated.

Read more about hydrocele and its treatment here.

Cancer and testicular torsion

Testicular cancer is an uncommon disease of the male genital area. With a careful attitude to his health and regular self-examination of the scrotum, a man can detect a seal at an early stage of the disease and consult a doctor in time. In this case, the disease is almost completely curable. In the later stages, the chance of a cure decreases.