What is Orchitis?
Orchitis is a condition where one or both testicles become inflamed. This swelling can be caused by bacteria or viruses. Testicles are two oval-shaped organs in the male reproductive system located in the scrotum. They are vital for producing male sex hormones and sperm.
The testicles are connected to a network of nerves called the testicular plexus, which originate from the renal (related to kidneys) and aortic (connected to the heart’s main artery) plexus. Blood is supplied to the testicles by a paired artery called the testicular artery, which starts from the large artery in the abdomen, the abdominal aorta, and goes through a passageway in the lower body called the inguinal canal, located inside the spermatic cord. The blood after circulation is drained through a network of veins known as the pampiniform plexus.
Since testicles are originally located behind the abdominal cavity (retroperitoneal organs), they drain waste fluids through lymph nodes situated alongside the abdominal aorta (para-aortic lymph nodes), while the scrotum drains through lymph nodes in the groin (superficial inguinal lymph nodes).
Orchitis can be acute (sudden and severe) and have symptoms, or it could be chronic (long-term) and not exhibit any symptoms. Isolated orchitis, which only affects the testicles, is quite rare. It usually is accompanied by an infection in the epididymis, a tube located at the back of the testicles that helps in carrying sperm. Orchitis often spreads through the bloodstream. Infections can also rise from the lower parts of the body and involve the testicles.
What Causes Orchitis?
Orchitis, which is inflammation of the testicles, can be caused by different types of bacteria and viruses.
In young patients, it’s usually caused by viruses like mumps and rubella, which are the most common causes. There have also been some cases of orchitis following the MMR vaccine, which protects against measles, mumps, and rubella. Other viruses that can cause orchitis include coxsackievirus, varicella, echovirus, and cytomegalovirus.
Bacterial infections can also lead to orchitis. This can happen when there’s an infection in the prostate or urinary tract. Common bacteria that can cause orchitis include E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus and Streptococcus species.
For men who are sexually active, orchitis can be result of sexually transmitted infections. The organisms that cause these infections include Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum.
In patients with weakened immune systems, orchitis can be caused by other organisms such as Mycobacterium avium complex, Cryptococcus neoformans, Toxoplasma gondii, Haemophilus parainfluenzae, and Candida albicans.
There are also some cases where orchitis is caused by the body’s immune system mistakenly attacking its own cells. This can be categorized as primary or secondary.
Risk Factors and Frequency for Orchitis
Orchitis, which is an inflammation of the testicles, is quite rare and usually goes hand in hand with an inflammation of the tube at the back of the testicles, known as epididymitis. Because of this, it’s hard to know how many cases of orchitis occur. Additionally, existing research doesn’t point to any particular race or religion being more likely to get orchitis.
- About 14% to 35% of males who have reached puberty and get mumps will also develop orchitis.
- Symptoms of orchitis show up 4 to 8 days after the onset of mumps, but orchitis can also happen without mumps.
- The mumps virus is usually the cause of orchitis when it occurs on its own without epididymitis.
Signs and Symptoms of Orchitis
Patients usually experience sudden onset of pain in one testicle, which can then spread to the entire scrotum. They may also start feeling tired and weak, show signs of fever, and experience chills.
Upon examination, doctors might find that the testicle is larger than usual, tender, and hard. There may also be swelling and redness in the scrotum. If the patient has both orchitis and epididymitis, the epididymis (a tube at the back of the testicles that stores and carries sperm) could be enlarged. However, the “cremasteric reflex” (a natural upward movement of the testicle when the inner thigh is rubbed) is normal. If the orchitis is caused by mumps, these symptoms usually occur 4 to 8 days after swelling in the parotid glands (major salivary glands located in the cheek area).
While assessing patients, clinicians should also pay attention to any risk factors to provide appropriate care.
Testing for Orchitis
Orchitis, or inflammation of the testicles, is normally diagnosed based on the patient’s symptoms and a physical examination by a doctor. Tests on bodily fluids aren’t usually needed, but sometimes a doctor might want to take a swab from the urethra (the tube that runs from your bladder out of the penis), or a urine sample. These tests are done to check if there’s a urinary tract infection or a sexually transmitted infection, which could be causing the symptoms of orchitis.
If a patient is feeling sudden and severe pain in the testicles or scrotum (the sack of skin surrounding the testicles), a more serious condition called testicular torsion needs to be ruled out. This is a medical emergency where the spermatic cord (which supplies blood to the testicles) becomes twisted, cutting off the blood supply to the testicles. To check this, doctors would typically use color Doppler ultrasonography of the scrotum, which is a type of ultrasound scan that uses sound waves to visualize the blood flow to the testicles.
In cases of orchitis caused by the mumps virus, the symptoms usually go away by the seventh day. Although it’s not typically done, there’s a blood test called serum immunofluorescence antibody testing, which can help confirm that the mumps virus is indeed causing the orchitis.
Treatment Options for Orchitis
In emergency situations, doctors need to determine whether the testes (the organs responsible for producing sperm) are experiencing torsion (where they twist around and cut off their own blood supply) or inflammation. Depending on the cause, you may not need antibiotics. For example, if a virus is causing the inflammation, antibiotics won’t help as they only work against bacteria. However, you can expect to be prescribed some treatments to ease your symptoms, such as rest, over-the-counter medication to lower fever and reduce pain, wearing a piece of clothing that gives scrotum support, and using hot or cold packs for pain relief.
The antibiotics your doctor prescribes will depend on what they think is the most likely cause of your condition. This will be determined by your age and your sexual history. If the doctor thinks that bacteria from the digestive system might be the culprit, they might prescribe antibiotics like fluoroquinolones (such as ciprofloxacin, ofloxacin, levofloxacin) or trimethoprim-sulfamethoxazole.
On the other hand, if there’s suspicion that a sexually transmitted bacterium is the cause of your symptoms, they might treat this with a single shot of an antibiotic called ceftriaxone and an antibiotic called doxycycline, which you’ll need to take twice daily. Alternatively, the doctor may prescribe azithromycin instead of doxycycline.
If a sexually transmitted infection is found, your sexual partners should also undergo treatment to prevent further spreading of the infection. Admission to the hospital for treatment may be required if you’re unable to take oral antibiotics, are showing signs of a severe body-wide infection (sepsis), or if outpatient therapy (treatment given without staying in the hospital overnight) has failed.
What else can Orchitis be?
Understanding the possible causes for acute scrotal pain and swelling is critical for properly treating patients. It’s important to quickly identify if the person is suffering from testicular torsion because this requires immediate medical intervention. Other possible causes that your doctor might consider include:
- Abscess formation (collection of pus)
- Hydrocoele (swelling in the scrotum due to fluid build-up)
- Epididymitis (inflammation of the tube at the back of the testicle) – this can often coexist with other conditions
What to expect with Orchitis
Generally, most cases of viral illness and those treated with antibiotics get better without any complications. These patients are often treated and monitored without having to stay at the hospital. It’s normal for some swelling and tenderness to remain even after completing a course of antibiotics, but the condition should notably improve. If symptoms don’t improve, it’s important to make sure the patient is taking the medication as directed, and further medical evaluation may be needed.
If a patient’s body temperature lowers within the first three days of starting an antibiotic treatment, it’s seen as a good sign of recovery. Similarly, most people dealing with mumps orchitis, a painful swelling in the testicles, also tend to get better within ten days.
Possible Complications When Diagnosed with Orchitis
The best way to avoid complications is through an accurate diagnosis and effective care of patients. Most patients recover completely, but there have been reported cases of the following complications:
- Shrunken testicles (This could occur in up to 60% of cases)
- Reduced ability to reproduce
- Inability to reproduce at all (though this is quite rare)
- Inflammation of the tube at the back of the testicle
- Excess fluid surrounding the testicle
In rare instances of severe bacterial infection in the testicles and the death of testicular tissue, a pocket of pus can develop that necessitates a surgical specialist’s involvement for proper management.
Preventing Orchitis
The key to preventing certain conditions lies mainly in staying away from things that increase your risk:
* Getting a mumps vaccine
* Practicing safe sex to avoid infections such as gonorrhea and chlamydia
* Not using urinary catheters for a prolonged period
* Undergoing surgery to fix any blockages in the urinary tract, if the patient qualifies
Doctors and nurses should strongly advise patients to complete their full course of antibiotics. This is important to prevent the bacteria from becoming resistant to the antibiotics and to stop the infection from coming back.
