By Teresa Rubio Asensio BSc, MSc (embryologist).
Last Update: 12/29/2014

Testicular orchitis consists on an inflammation of the testicle, generally due to a bacterial or viral infection, which may have its origin in the epididymis or the testicle itself. Orchitis can be unilateral (most common), or bilateral, when it affects both testicles, and it can become chronic if not treated. The worst case scenario is the necrosis of the organ, in which case it would be necessary to surgically remove the testicle.

It can cause male sterility, especially in those cases in which it is bilateral: due to the inflammation, the temperature of the testicle increases, hence damaging spermatogenesis. Another cause of sterility would be the atrophy of the vasa deferentia, once the inflammation has passed, which would reduce the concentration of spermatozoa when ejaculating.

Regarding male sterility and types of orchitis, bacterial orchitis can be treated and has better odds than those provoked by the mumps virus, which can produce sterility in men.

Testicular torsion

Causes

The infection can have its origin in sexual contact, due to a sexually transmitted disease (STD) such as gonorrhoea, syphilis or a type of chlamydia (Chlamydia Trachomatis).

Another possible cause would be a urine infection, which spreads through the urine tract until it reaches the testicle. A pathogen that causes it, among others, is E. Coli.

However, these are not the only causes: it can be provoked by the presence of bacteria or viruses. The Brucella bacteria produce an illness (brucellosis) that provokes high temperature and can produce orchitis in 5%-10% of the cases, which tends to be unilateral (it affects only one testicle). The bacillus of tuberculosis can provoke a testicular inflammation, as tuberculosis not only affects the lung, but also other organs. It’s generally linked with chronic orchitis. The viral orchitis is caused by the mumps virus. When mumps take place after puberty, the testicle can be affected in 20%-30% of the cases.

Symptoms

Even though it is not necessary that the patient manifests all symptoms, the most common ones are:

  • Problems when urinating, and pain while doing it.
  • Fever.
  • Nausea.
  • Decrease in the libido, since inflammation provokes a failure of the testicular function.
  • Increase in testicle volume.
  • Scrotum or testicle pain.
  • Germs in urine.

In the acute phase, severe orchitis takes place when the testicle might increase its size in up to five times, there’s a rise in temperature and acute pain. In the chronic phase of the inflammation, when the patient has endured the illness for over six weeks, the inflammation stops, the testicle sticks to the scrotum, turns fibrous and hardens.

Diagnosis

The diagnosis is carried out through palpation of the testicle. Pain, an increase in volume or scrotal asymmetry can lead to its diagnosis.

A sperm analysis or a urine analysis can also be performed, to check the presence of leukocytes in the ejaculated sample or identify the pathogen. A testicular ultrasound can also be carried out, to discard other causes such as a testicular torsion.

Leukocytes in sperm

In the case of children, an acute pain in the testicle must be distinguished from a testicular torsion, since the latter requires surgery and its treatment is more urgent.

Treatment

To treat the bacterial orchitis, antibiotics and anti-inflammatory drugs are used for a month. Painkillers are prescribed to relieve the pain. If it’s an orchitis caused by an STD, such as chlamydia or gonorrhoea, the partner of the patient will need to be treated too.

If orchitis is caused by a virus, the treatment consists only on painkillers to relieve the pain. Resting and keeping the testicles as high as possible is also recommended.

In most of the cases, orchitis disappears completely with time and it’s not linked with any severe illness. As a consequence of it, a testicle may become smaller (atrophy), which may affect the testicle function (spermatogenesis) and provoke male sterility, especially in cases of bilateral orchitis.

Viral orchitis can be prevented by being vaccinated against mumps and by using condoms, for those cases of orchitis caused by sexually transmitted diseases.

Authors and contributors

 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