Orchitis is inflammation of the testicles that is typically caused by either a bacterial infection or a viral infection. Though a painful condition, it usually does not have severe or lasting complications.
Definition & Facts
Orchitis is inflammation that affects one or both testicles. Orchitis can be acute or chronic. The most common pathogen that causes orchitis is the mumps virus, and orchitis is the most common complication of mumps among sexually mature males.
The Centers for Disease Control and Prevention estimate that orchitis affected between 12-66% of men with mumps in an era when the mumps vaccine was not widely used. Now that the vaccine is widely used, that percentage range of men with mumps who develop orchitis as a complication of the viral infection has dropped to 3-10%.
Orchitis is often seen in tandem with epididymitis, which is inflammation of the epididymis. When the two occur together, they are the most common sources of pain in an adult's scrotum. The epididymis is the coiled tube that sits behind the testicle and transfers sperm from the testicle to the vas deferens.
Epididymitis is usually caused by a bacterial infection which can then spread to the testicles and cause orchitis. The most common pathogen that causes epididymitis among males between the ages of 14-35 is Neisseria gonorrhoeae: the same bacterial pathogen that causes gonorrhea, a bacterial infection and sexually transmitted disease.
The most common pathogen that causes epididymitis among males under the age of 14 is Escherichia coli or E. coli. The age range for men who are likely to be diagnosed with orchitis as a result of a sexual transmitted infection is 19-35. Men can also develop bacterial orchitis if they have chronic bladder infections.
Symptoms & Complaints
Other symptoms depend on the underlying cause of the inflammation. If the infection is caused by a viral infection, it is likely the individual will develop flu-like symptoms. These symptoms include nausea, fever, and vomiting.
If orchitis is due to mumps, symptoms in the testicles can appear a week after symptoms of parotitis appears, which is the inflammation of the parotid glands that commonly occurs as a result of mumps and causes the face to appear swollen.
Orchitis can lead to major complications including male infertility, though this is exceptionally rare. Other rare complications include testicular atrophy which is a condition in which the structure and function of the testicle is compromised.
Scrotal abscesses are another rare complication. This may occur when the enlargement of various structures in the epididymis and testicles due to inflammation starts compromising the vascular structures within the testicle. This leads to infection and even necrosis. If someone suspects that they have orchitis, it is best that they see a doctor as soon as possible.
In addition to being caused by mumps, orchitis can occur as a complication of medical treatment. Long-term use of Foley catheters can cause orchitis. If one has to use a Foley catheter, they need to make sure that the area is cleaned properly on a daily basis and that the tubing is changed out on a regular basis. Additionally, some people develop orchitis after having surgery on their urethra.
Another way to develop orchitis is through a bacterial infection (bacterial orchitis). This is usually the result of unsafe sex safe with someone who has gonorrhea or chlamydia. Sometimes a cause cannot be determined for the orchitis in which case it is said to be idiopathic.
Diagnosis & Tests
After the patient presents symptoms of orchitis to the doctor, he or she will run multiple tests. The most important test they will do is the basic physical examination. During the physical, they will check the patient's lymph nodes and the affected testicle. The doctor may want to do a prostate exam to check for tenderness or enlargement.
After the physical examination, they will likely want to run urine tests, and they will also likely run an STI screening. An STD test will involve swabbing the tip of the penis to collect discharge from the urethra. This test will reveal any sexually transmitted diseases that could have caused the orchitis.
In addition to this lab work, if the orchitis is severe they may also do an ultrasound. The ultrasound is used to rule out any severe conditions that cause similar symptoms such as testicular torsion, a serious medical emergency in which the blood supply is cut off due to the spermatic cord twisting around the vascular structures of the testicle. It is important to rule out this dangerous condition.
Doctors may also do a nuclear scan of the testicles. With this test, they will inject a radioactive tracer into the patient's bloodstream. This test will enable the physician to see how well the blood flow is to the testicles.
Treatment & Therapy
Once the physicians have come to the conclusion of orchitis, there are different treatments depending on the cause of orchitis. If the patient has bacterial orchitis, the physicians will prescribe antibiotics that will fight the bacteria. It may take weeks for the tenderness in the testicles to stop, even with the antibiotics.
While the recovery time is slow, there are many treatments that can lessen the discomfort of orchitis. Athletic straps will help to elevate the testicles and give them the extra support necessary to relieve some discomfort and reduce the risk of testicular trauma. Ice packs and pain relievers can be used to relieve some of the pain from the swollen testicles.
Healthcare professionals can provide those affected with anti-inflammatory medication to reduce the swelling of the testicles. Bed rest and elevation of the testicles are important for recovery and symptom mitigation. If someone has been affected by orchitis, they must not lift heavy objects.
Prevention & Prophylaxis
It is also important to practice safe sex in order to prevent orchitis. Use of condoms and other barriers can reduce the risk of contracting a sexually transmitted disease that leads to painful conditions such as orchitis.