Orchitis

By (gynecologist), BSc, MSc (embryologist), BSc, MSc (embryologist) and (invitra staff).
Last Update: 12/29/2014

Orchitis is the inflammation of the testicle accompanied with intense pain which is caused by a general traumatism or infection at the epididymis level or at the testicle itself.

Orchitis can be unilateral when only one testicle is affected or bilateral when both of them are inflamed. In the most severe cases, orchitis can become chronic when left untreated.

Men with orchitis may suffer from sterility apart from other symptoms and could even develop azoospermia. For this reason, it is important to apply the most appropriate treatment as soon as possible.

Below you have an index with the 8 points we are going to deal with in this article.

Causes

The main cause of orchitis is an infection caused by microorganism. Depending on the causing agent, one can distinguish between bacterial orchitis and viral orchitis with the last one being the most frequent.

In the following section, we will list all possible causes that can lead to inflamed testicles:

Mumps virus
May occur in children after puberty and develop in what it’s popularily known as parotid orchitis.
Sexually Transmitted Infections
The most common ones are bacteria that cause gonorrhea, syphilis or chlamydia.
Urine infection
Can extend through the urinary tract to the testicle. The most common bacteria in this case is E. Coli.
Infections in the prostate or epididymis
can extend to the testicle. In the latter case, the disorder is known as orchiepididymitis.
Brucellosis
disease caused by Brucella bacteria that can lead to unilateral orchitis in 5-10% of cases.
Tuberculosis.
the tuberculosis bacillus can also cause testicular inflammation associated with chronic orchitis.
Other
introduction of catheters or medical instruments into the penis, which will result in traumatic orchitis

Risk Factors

Men between the ages of 19 and 35 are more likely to suffer from sexually transmitted orchitis. In this case, the risk factors are as follows:

  • Having frequent sexual relations with different partners.
  • Having a previous history of sexually transmitted disease (STD) such as gonorrhea.
  • Having a partner with a diagnosed STD.
  • Not using a condom.

When orchitis has causes other than sexual transmission, these are the risk factors:

  • Being over 45 years of age.
  • Not being vaccinated against mumps.
  • Having regular urinary tract infections.
  • Having performed surgery on the urinary tract.
  • Being born with urinary tract abnormalities.
  • prolonged use of a Foley catheter (drainage and collection of urine from the bladder).

Therefore, the most appropriate actions to prevent the risk of orchitis are mumps vaccination and safe sex.

Symptoms

The symptoms of orchitis usually appear suddenly and can vary from mild to severe depending on the condition of each patient.

We will now comment on the most common clinical manifestations, although it is not always necessary that they all occur:

  • Pain in the testicle
  • Swelling in the scrotum
  • Blood in ejaculated semen (hematospermia)
  • Fever
  • Groin pain
  • Painful urination
  • Pain during sex
  • Abnormal discharge from the penis
  • Tender, swollen, heavy feeling testicle
  • Nausea
  • Decreased libido

The acute phase of orchitis corresponds to an increase of up to 5 times the size of the testicle, accompanied by a rise in temperature and a lot of pain.

However, in the chronic phase, when the pain persists for more than 6 weeks, the testicle stops being inflamed, sticks to the scrotum, becomes fibrous and hardens. This is what is known as testicular atrophy.

Diagnosis

Orchitis is detected when the man has a lot of pain and discomfort in the testicle. In that case, it is advisable to go to the doctor immediately.

The diagnosis is made by palpation of the testicle where the presence of pain, redness, increased volume, scrotal asymmetry, as well as the other symptoms we have already mentioned, will be detected.

As a complementary test, it is advisable to perform a urine and a semen analysis to detect the presence of leukocytes in the ejaculate and identify if there is any pathogenic organism.

A testicular ultrasound may also be performed to rule out other causes of pain, such as pain from testicular torsion.

This is especially important in the case of children since testicular torsion needs surgery and its treatment is more urgent.

On the other hand, painless inflammation of the testicle may be a sign of testicular cancer, and therefore more diagnostic tests will be needed.

Orchitis and Infertility

Orchitis can have complications that end up leading to male sterility, which will be more or less severe depending on whether it affects one or both testicles.

Testicular inflammation causes the temperature of the testicle to rise, which negatively affects the process of spermatogenesis (sperm production).

The testicles are located in the scrotal pouch at a lower temperature than the rest of the body, about 34ºC, to allow the correct formation of sperm.

Another cause of infertility is caused by atrophy of the seminiferous ducts. This results in a blockage that decreases the concentration of sperm in the ejaculate, an alteration known as oligozoospermia.

In the most severe cases of ischemic orchitis with testicular atrophy of both testicles, the male will have a total absence of sperm (azoospermia), as well as a deficit of the hormone testosterone.

Finally, necrosis of the testicular tissue may require complete removal of the testicle (orchiectomy).

Treatment

In most cases, orchitis disappears completely over time and is not associated with any serious illness, although there may be some after-effects that affect fertility as we have already mentioned.

In general, orchitis of bacterial origin has a better prognosis than viral orchitis. Treatment consists of taking antibiotics to eliminate the causative agent, while in mumps orchitis the only goal of therapy is to relieve the symptoms.

Some of the recommendations that the patient should follow are the following:

  • Taking anti-inflammatory drugs
  • Taking painkillers for pain
  • Rest in bed with elevated scrotum with a towel
  • Apply cold compresses to the scrotum area

It should be noted that in orchitis caused by an STD such as gonorrhea or chlamydia, antibiotic treatment should also be administered to the affected partner.

On the other hand, parotid orchitis cannot be treated and can, therefore, lead to more serious consequences such as testicular atrophy.

Patients who have suffered from orchitis with a sterile outcome will have to resort to assisted reproduction treatment if they wish to become parents, including sperm donation in the most serious cases.

FAQs from users

Suggested for you

Azoospermia is a cause of infertility characterized by not finding sperm in the ejaculate. If you want to read more about this, you can enter the following post: What is azoospermia?

We have mentioned the semen analysis as a diagnostic test for orchitis. To know what it is in detail, we recommend you read the following article: How is a semen analysis report performed?

The presence of pyocytes on the seminogram will confirm that there is an infection in the male reproductive tract. For more information on this, you can read on here: Leukospermia and treatment.

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Authors and contributors

Dr. Mónica  Aura Masip
Dr. Mónica Aura Masip
Gynecologist
Dr. Mónica Aura has a degree in Medicine and General Surgery from the Autonomous University of Barcelona (UAB). She is also a specialist in Gynecology and Obstetrics from the Hospital de Santa Creu y Sant Pau and has a Master's degree in Human Assisted Reproduction from the University Juan Carlos I of Madrid and another in Health Center Management from the UB. More information about Dr. Mónica Aura Masip
Licence number: 31588
 Teresa Rubio Asensio
Teresa Rubio Asensio
BSc, MSc
Embryologist
Master's Degree in Medicine and Reproductive Genetics from the Miguel Hernández University of Elche (UHM). Teacher of different Clinical Embryology courses at the UHM. Member and writer of scientific contents at ASEBIR and ASPROIN. Embryologist specializing in Assisted Procreation at UR Virgen de la Vega. More information about Teresa Rubio Asensio
 Zaira Salvador
Zaira Salvador
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English and German edition of inviTRA. More information about Romina Packan

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