Inflammation of the Testicle (Orchitis)

• Orchitis is an inflammatory condition of one or both testicles in males, generally caused by a viral or bacterial infection.
• Most cases of orchitis in children are caused by infection with the mumps virus.
• Orchitis caused by a bacterial infection most commonly develops from the progression of epididymitis, an infection of the tube that carries semen out of the testicles. This is called epididymo-orchitis.
• The majority of cases of mumps orchitis occur in prepubertal (less than 10 years old) males, while most cases of bacterial orchitis occur in sexually active men, or in men older than 50 years of age with benign prostatic hypertrophy.

Orchitis in children most commonly occurs as a result of a viral infection.

• The virus that causes mumps is most commonly implicated as the cause of orchitis.
• Approximately one-third of boys will develop orchitis from mumps infection.
• It is most common in young boys, and testicular inflammation typically develops 4-6 days after the onset of mumps.
• There are case reports of mumps orchitis occurring after immunization with the mumps, measles, and rubella (MMR) vaccine, but this is rare.
• Other less common viral organisms which can cause orchitis include varicella, Coxsackievirus, echovirus, and cytomegalovirus (associated with infectious mononucleosis).

Less commonly, orchitis can be caused by a bacterial infection. Generally speaking, most cases of bacterial orchitis occur from the progression and spread of epididymitis (inflammation of the coiled tube on the back of the testicle), either from a sexually transmitted disease (STD) or from a prostate gland/urinary tract infection. This condition is termed epididymo-orchitis.

• Bacteria that can cause orchitis from prostate gland/urinary tract infections include Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus and Streptococcus species.
• Bacteria that cause sexually transmitted diseases, such as gonorrhea, chlamydia, and syphilis, can cause orchitis in sexually active men, typically between the ages of 19-35 years. People may be at risk if they have many sexual partners, are involved in high-risk sexual behaviors, if their sexual partner has had an STD, or if the person has a history of STDs.

Individuals may be at risk for non-sexually transmitted orchitis if they have not been immunized against mumps, if they get frequent urinary tract infections, if older than 45 years of age, or if they frequently have a catheter placed into their bladder.

The symptoms associated with orchitis may range from mild to severe, and the inflammation may involve one or both testicles. Patients may experience the rapid onset of pain and swelling, or the symptoms may appear more gradually. Symptoms of orchitis may include the following:

• Testicular swelling
• Testicular redness
• Testicular pain and tenderness
• Fever and chills
• Nausea
• Malaise and fatigue
• Headache
• Body aches
• Pain with urination

In epididymo-orchitis, the symptoms may come on and progress more gradually.

• Epididymitis initially causes a localized area of pain and swelling on the back of the testicle for several days.
• Later, the infection increases and spreads to involve the whole testicle.
• Possible pain or burning before or after urination and penile discharge may also be seen.

Individuals who experience testicular pain, redness, or swelling should promptly seek medical care and evaluation. Do not delay medical care as other emergency conditions, such as testicular torsion (twisting of the spermatic cord), are also characterized by testicular pain and tenderness. If the affected male is unable to promptly see his health care practitioner, go to an emergency department. Also, if the person has been evaluated and their condition continues to worsen, they should seek medical care.

Generally speaking, the diagnosis of orchitis can be established after a history and physical exam have been performed by a health care practitioner. However, imaging studies and laboratory testing may be undertaken to evaluate and exclude other medical conditions which may present with similar symptoms to those of orchitis.

• An ultrasound of the affected testicle(s) may be ordered to exclude other conditions (for example, testicular torsion, abscess, or epididymitis) which may cause similar symptoms.
• With a rectal exam, a health care practitioner can check the prostate gland for infection. This test is necessary because antibiotic treatment will be used for a longer period of time if the infection involves the prostate gland.
• A sample of discharge taken from the urethra, the tube that forms the opening at the end of the penis, may be obtained to identify which bacteria are responsible for the infection if a sexually transmitted disease is suspected.
• Blood work and a urinalysis may be obtained depending on the patient's symptoms.

Home care along with the right medical treatment can help improve symptoms.

• Over-the-counter nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil or Motrin, for example) or naproxen (Aleve) and acetaminophen (Tylenol) may help with pain. Narcotic pain medications may be prescribed at the discretion of the health care practitioner if pain is severe.
• Elevating the scrotum with snug-fitting briefs or an athletic supporter can increase comfort.
• Apply ice packs to the scrotal area.
  • Ice should not be directly applied to the skin because this may cause burns from freezing. Rather, the ice should be wrapped in a cloth and then applied to the scrotum.
  • The ice packs may be applied for 10-15 minutes at a time, several times a day for the first 1-2 days. This will help reduce the swelling (and pain).

The medical treatment of orchitis depends on the underlying cause of infection, specifically whether it is caused by a bacterial or viral organism.

People with bacterial orchitis or bacterial epididymo-orchitis require antibiotic treatment. Antibiotic therapy is necessary to cure the infection.

• Most men can be treated with antibiotics at home for 10-14 days. Longer courses may be required if the prostate gland is also involved.
• If a patient has high fever, is vomiting, if he is very ill, or if he develops serious complications, the patient may require admission to a hospital for IV antibiotics.
• Young, sexually active men need to make sure that all of their sexual partners are treated if the cause is determined to be a STD. They should either use condoms or abstain from sexual relations until all partners have completed their full course of antibiotics and are symptom-free.
• Antibiotics prescribed will depend on the patient age and underlying cause of the bacterial infection. Antibiotics commonly used may include ceftriaxone (Rocephin), doxycycline (Vibramycin, Doryx), azithromycin (Zithromax) or ciprofloxacin (Cipro).

If the cause of orchitis is determined to be viral in origin, antibiotics will not be prescribed. Mumps orchitis will generally improve over a 1-2 week period. Patients should treat symptoms with the home care treatments outlined above.

Individuals diagnosed with orchitis should follow-up with their health care practitioner to ensure improvement, and to monitor for the development of any potential complications. Certain patients may require referral to a urologist. Call a health care practitioner or go to the emergency department if a person's symptoms worsen at any time during treatment.

Certain measures can be taken to reduce the risk of developing orchitis.

• Immunization against mumps can prevent mumps orchitis.
• Choose not to have intercourse in high-risk situations where individuals may be exposed to sexually transmitted diseases (STDs). Condom use reduces the incidence of sexually transmitted diseases.
• Men older than 50 years of age should have their prostate gland examined during their yearly physical exams.

Generally speaking, most cases of viral orchitis and antibiotic treated bacterial orchitis will improve without complications. However, certain potential complications that can be encountered include:

• Some individuals with orchitis may experience shrinkage (atrophy) of the affected testicle
• Impaired fertility, or rarely sterility
• Repeated episodes of epididymitis
• Scrotal abscess
• If left untreated, rarely loss of testicle or death.