orchitis is inflammation of one or both testicles. It is most often caused by bacterial or viral infections, although the cause may be unknown. Inflammation can cause testicular pain and swelling, sometimes severe.
Orchitis may occur at the same time as testicular infection epididymis (the spiral tube that carries sperm from the testicles) or the prostate (the walnut-sized organ below the bladder that produces semen). If not treated properly, orchitis can lead to complications, including infertility.
This article looks at the symptoms, complications, and causes of orchitis. It also walks you through how to diagnose, treat, and prevent the condition, as well as what to expect from the outcome.
Symptoms of orchitis tend to develop suddenly and may be limited to the testicles (also known as testicles) or deep into the groin.When the epididymis is involved, the condition is called epididymo-orchitis.
Depending on the severity and underlying cause, signs and symptoms may include:
- pain or tenderness in one or both testicles
- Visible swelling in one or both testicles
- one or both testicles are heavy
- groin tenderness or pain
- Painful urination
- Pain during intercourse or ejaculation
- discharge from the penis
- blood in semen
If left untreated, orchitis can lead to serious complications in some people. Inflammatory damage to the testis or adjacent structures such as the epididymis is sometimes irreversible.
Possible complications of orchitis include:
- Scrotal abscess (a pocket of pus in the scrotum, the sac that houses the testicles)
- Testicular atrophy (shrinking of the affected testicle)
- Testicular infarction (death of testicular tissue)
- Infertility (due to damage to the testis and/or epididymis)
Testicular pain and swelling are the main features of orchitis. Depending on the underlying cause, there may also be fever, groin pain, painful urination or intercourse, and a noticeable discharge from the penis. If left untreated, severe orchitis can lead to infertility.
Signs that testicular pain may be serious
Orchitis is most often caused by a bacterial or viral infection. It mainly affects adults, but can eventually affect people of any age with testicles.
Orchitis can even affect young children due to childhood viral infections such as mumps, rubella (German measles), or chickenpox (chickenpox). Mumps is by far the most common cause of orchitis in children, especially in children 14 and older. Mumps in adults with testicles can lead to infertility.
In adults, bacterial infections are the most common cause of orchitis (although there are some viral and fungal causes). These include:
- Sexually transmitted infections (STIs) such as chlamydia, gonorrhea, and syphilis
- Bacterial urinary tract infection (UTI)
- Prostate bacterial infection
- Spread (widespread) infections in immunocompromised people, including toxoplasmosis, cytomegalovirus (CMV) and Candidiasis
There are certain factors that increase a person’s risk of developing orchitis. Risk factors may vary depending on the type of infection involved.
Risk factors for orchitis associated with sexually transmitted infections include:
- bareback sex
- multiple sexual partners
- Past history of gonorrhea or other sexually transmitted infections
- Aged between 19 and 35
Risk factors for orchitis unrelated to STIs include:
- benign prostatic hyperplasia (enlarged prostate)
- recurrent urinary tract infection
- Long-term use of a Foley catheter (a tube used to drain urine from the bladder)
- urethral stricture (narrowing of the urethra, the tube a person passes through to pass urine from the bladder when urinating and ejaculate)
- congenital malformations of the urinary tract
- Urology Surgery
- untreated advanced HIV infection
- Under-vaccination against mumps
Orchitis can affect teens, teens, young adults, and even younger children. In children, viral infections such as mumps are the most common causes. In adults, most cases are bacterial infections, including sexually transmitted infections.
Common and Uncommon Causes of Testicular Pain
The diagnosis of orchitis begins with a physical examination and a review of your symptoms and medical history. Laboratory and imaging tests can help pinpoint the exact cause of your condition.
As part of the physical exam, the doctor will examine the testicles and urethraThe doctor will also palpate (lightly touch and press) the surrounding area, including the groin, to check for any symptoms such as pain, tenderness, or swollen lymph nodes.
Check if there is prostatitis (prostate inflammation), the doctor will perform a digital rectal examination (DRE), in which a gloved, lubricated finger is inserted into the rectum to check the size of the prostate.
Laboratory and Imaging Tests
Blood and urine tests are often used to diagnose orchitis. Not only can this help pinpoint the cause of your symptoms, but it can also rule out other potentially serious problems (such as testicular cancer). Imaging tests can help diagnose or describe the severity of the condition.
Laboratory and imaging tests commonly used to diagnose orchitis include:
- Complete blood count (CBC), which can detect signs of infection
- Urinalysis, which can help detect urinary tract infections and some sexually transmitted infections
- Urine cultures, which can identify bacterial causes of UTIs
- urethral swab to test for gonorrhea or chlamydia
- Complete STI panel, blood test panel for diagnosing STI
- Testicular ultrasonography, a non-invasive imaging tool especially useful for diagnosing epididymo-orchitis
Your doctor may also order tests to rule out potentially serious conditions with similar features. This is called a differential diagnosis.
Conditions commonly investigated in the differential diagnosis of orchitis include:
- Testicular torsion (a medical emergency caused by an abnormally twisted testicle)
- hydrocele (accumulation of fluid in the scrotum due to injury or infection)
- Testicular cancer (diagnosed by ultrasound and removal of the testicle)
- Prostate cancer (sometimes spreads to the testicles)
- Urinary retention (when your bladder doesn’t empty, putting you at risk of infection)
Diagnosing orchitis may involve a physical exam, reviewing your medical history and symptoms, various blood and urine tests, and testicular ultrasound.
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Treatment for orchitis may vary depending on the underlying cause. Some mild cases do not require treatment, and remission begins after a few days. If the cause is a bacterial infection or a sexually transmitted infection, treatment is required.
Treatment options for orchitis include:
- Bed rest as the scrotum rises
- ice packs for no more than 15 minutes several times a day to reduce swelling
- Anti-inflammatory drugs, such as Advil (ibuprofen) or Aleve (naproxen)
- Oral pain relievers like Tylenol (acetaminophen)
- Antibiotics for bacterial infections, including bacterial STIs like gonorrhea, chlamydia, and syphilis
Antibiotics are usually prescribed for 10 to 14 days. Sexual partners also need to be treated if sexually transmitted infections are involved. Sexual activity should be avoided until the infection is completely cleared and your doctor agrees with you.
When recovering, avoid lifting heavy objects as this can cause pressure on the groin and increase pain. Move around as little as possible and wear a wrist brace to help stabilize and support the scrotum.
If bacterial infections (including bacterial STIs) are involved, treatment of orchitis may include bed rest, scrotal stents, ice packs, oral pain relievers, anti-inflammatory drugs, and antibiotics.
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Most cases of orchitis caused by a virus or treated with antibiotics resolve without any further complications. There may still be swelling and tenderness after antibiotic treatment is complete, but a drop in body temperature during the first three days is usually a good sign that the infection is gone.
An exception is mumps orchitis, where 50% of adult penises experience testicular atrophy, and an estimated 1 in 10 will experience a drop in sperm count. In rare cases, the drop may be enough to cause infertility.
Most cases of mumps orchitis resolve within 10 days.
Most viral causes of orchitis or orchitis treated with antibiotics resolve without complications. The only exception may be mumps orchitis, where some adults experience testicular atrophy and a drop in sperm count.
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Since sexually transmitted infections are the leading cause of orchitis, you can reduce your risk by practicing safer sex. This includes consistent condom use and reducing the number of sexual partners.
The mumps vaccine is also an important way to prevent orchitis. This is given as the measles, mumps and rubella (MMR) vaccine and is recommended for all children in two doses. Adults born after 1957 can also receive one or two doses of the MMR vaccine. (Presumably, people born before 1957 are immune to mumps.)
You can also reduce your risk of orchitis if you have an enlarged prostate. Benign prostatic hyperplasia (BPH) can be controlled with drugs such as Flomax (tamsulosin), which relax the prostate muscles, or Proscar (finasteride), which help shrink the gland itself.
The risk of orchitis can be reduced by practicing safe sex, getting the mumps vaccine, and controlling benign prostatic hyperplasia (BPH).
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Orchitis is inflammation of one or both testicles, mainly caused by bacterial or viral infections. Symptoms include testicular pain and swelling, as well as fever, groin pain, painful intercourse, painful urination, and a noticeable discharge from the penis.
Orchitis can affect anyone with testicles, including adults, teens, teens, and even young children. Common causes include mumps, bacterial urinary tract infections, bacterial prostate infections, and sexually transmitted infections such as gonorrhea, chlamydia, or syphilis.
Orchitis can be treated with bed rest, a scrotal stent, ice packs, anti-inflammatory drugs, oral pain relievers, and antibiotics. Most viral cases and those treated with antibiotics will recover without any further complications.
If left untreated, severe orchitis can lead to testicular shrinkage and infertility. Safer sex and mumps vaccination can significantly reduce risk.
Although it may seem embarrassing to talk to your doctor about a swollen, painful testicle, don’t let embarrassment get in the way of seeking a proper diagnosis. This includes the diagnosis and treatment of sexually transmitted infections. Even if the acute symptoms go away, you may still suffer damage that affects your ability to have children in the future.
Your symptoms may also be due to a more serious condition, such as testicular torsion or testicular cancer. Regardless of the cause of testicular pain, early diagnosis and treatment almost always improves outcomes.