Orchitis

If you're an adult male, you may have heard that getting mumps may affect your fertility. The reason is viral orchitis, an inflammation of one or both testicles, most commonly associated with the virus that causes mumps. About one-third of males who contract mumps develop orchitis.

Fortunately, infertility as a result of mumps-related orchitis is rare, especially when only one testicle becomes inflamed.

Other causes of orchitis usually are bacterial, including sexually transmitted diseases (STDs). The best way to prevent orchitis is to prevent mumps and to avoid behaviors that may result in STDs.

Signs and symptoms

Orchitis symptoms usually have an abrupt onset. They may include:

Testicular swelling on one or both sides
Pain ranging from mild to severe
Tenderness in one or both testicles
Nausea
Fever
Discharge from penis
Blood in semen

The terms "testicle pain" and "groin pain" are sometimes used interchangeably. But groin pain occurs in the fold of skin between the thigh and abdomen — not in the testicle. As well, the causes of groin pain are different from the causes of testicle pain.

Causes

A number of bacterial and viral organisms can lead to orchitis.

Bacterial orchitis
Most often, bacterial orchitis is the result of epididymitis, an inflammation of the coiled tube (epididymis) that connects the vas deferens and the testicle. The vas deferens carries sperm from your testicles. When inflammation in the epididymis spreads to the testicle, the resulting condition is known as epididymo-orchitis.

Epididymitis usually is caused by an infection of the urethra or bladder that spreads to the epididymis. Often the cause of the infection is an STD, particularly gonorrhea or chlamydia. The highest incidence of sexually transmitted epididymo-orchitis occurs in men ages 19 to 35. Non-sexually transmitted forms of the infection may be related to anatomical abnormalities in the urinary tract or having had a catheter or medical instruments inserted into the penis.

Viral orchitis
Most cases of viral orchitis are the result of mumps. About one-third of males who contract the mumps after puberty develop orchitis during their course of the mumps, usually four to six days after onset.

Risk factors

Several factors may contribute to developing orchitis. For non-sexually transmitted orchitis, they include:

Not being immunized against mumps
Being older than 45
Recurring urinary tract infections
Surgery that involves the genitals or urinary tract, because of the risk of infection
Malformations in the urinary tract present at birth (congenital)

High-risk sexual behaviors that can lead to STDs also put you at risk of sexually transmitted orchitis. They include having:

Multiple sexual partners
Sex with a partner who has an STD
Sex without a condom
A personal history of an STD
When to seek medical advice

If you experience pain or swelling in your scrotum, especially if the pain comes on suddenly, contact your doctor.

A number of conditions can cause testicular pain, and some of the conditions require immediate treatment. One such condition involves twisting of the spermatic cord (testicular torsion), which may cause pain similar to that caused by orchitis. Your doctor can administer diagnostic tests to determine which condition is causing your pain.

Screening and diagnosis

Your doctor will conduct a physical exam, which may reveal enlarged lymph nodes in your groin and an enlarged testicle on the affected side; both may be tender to the touch. Your doctor also may do a rectal examination to check for prostate enlargement or tenderness and order blood and urine tests to check for infection and other abnormalities.

Other tests your doctor might order to determine the presence of an STD and to rule out the possibility of testicular torsion, which requires immediate treatment, include:

STD screening. This involves obtaining a sample of discharge from your urethra. Your doctor may insert a narrow swab into the end of your penis to obtain the sample, which will be viewed under a microscope or cultured to check for gonorrhea and chlamydia.

Ultrasound imaging. This test, which uses high-frequency sound waves to create precise images of structures inside your body, may be used to rule out twisting of the spermatic cord (testicular torsion) and determine increased blood flow to your testicle, which helps confirm the diagnosis of orchitis.

Nuclear scan of the testicles. Also used to rule out testicular torsion, this test involves injecting trace amounts of radioactive material into your bloodstream. Special cameras then can detect areas in your testicles that receive less blood flow, indicating torsion, or more blood flow, confirming the diagnosis of orchitis.

Complications

Complications of orchitis may include:

Testicular atrophy. Orchitis may eventually cause the affected testicle to shrink.

Scrotal abscess. The infected tissue fills with pus.

Repeated epididymitis. Orchitis can lead to recurrent episodes of epididymitis.

Infertility. In a small number of cases, orchitis can impair fertility; however, if orchitis affects only one testicle, sterility is even less likely.

Treatment

Treatment depends on the cause of orchitis.

Treating viral orchitis
Treatment for viral orchitis, the type associated with mumps, is aimed at relieving symptoms. Your doctor may prescribe pain medication, nonsteroidal anti-inflammatory drugs, such as ibuprofen (Motrin, Advil, others) or naproxen (Aleve, Anaprox, others), and recommend bed rest, elevating your scrotum and applying cold packs.

Treating bacterial orchitis
In addition to measures to relieve discomfort, bacterial orchitis and epididymo-orchitis require antibiotic treatment. If the cause of the infection is an STD, your sexual partner also needs treatment.

Antibiotic drugs most commonly used to treat bacterial orchitis include ceftriaxone (Rocephin), ciprofloxacin (Cipro), doxycycline (Vibramycin, Doryx), azithromycin (Zithromax), and trimethoprim and sulfamethoxazole combined (Bactrim, Septra). Make sure your doctor is aware of any other medications you're taking or any allergies you have. This information, as well as whether your infection is sexually transmitted and what type of STD you have, will help your doctor select the best treatment.

Be sure to take the entire course of antibiotics recommended by your doctor. Even if your symptoms clear up sooner, complete the course to ensure that the infection has been eradicated.

Prevention

Getting immunized against mumps is your best protection against viral, mumps-related orchitis. Having sex with just one partner and using a condom helps protect against STDs.

Self-care

To ease your discomfort, try these suggestions:

Rest in bed.
Lie down so that your scrotum is elevated.
Apply cold packs to your scrotum as tolerated.

Adapted from: Mayo Foundation for Medical Education and Research