Orchitis

Definition
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.

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.

Tests 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.

Treatments and drugs

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.

Lifestyle and home remedies

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.