Testicular Torsion vs. Infection

• Testicular torsion is a painful condition of the testicle due to twisting the spermatic cord that causes loss of blood to the testicle. This a surgical emergency, as torsion is the most common cause of testicle loss in adolescent males. Testicle infection (also termed testicular infection and/or orchitis) generally means infection of the testicles by various bacteria and/or viruses. Testicular infections may spread to structures attached to the testicles such as the epididymis (termed epididymo-orchitis).
• Testicular torsion is only one type characterized by excruciating testicular pain in one testicle; in contrast, testicle infections types vary according to the infecting organism (various bacteria species and viral species).
• Testicular torsion is a medical emergency that can be cured only by a twisting the spermatic cord of the testicle, usually done by surgery. Most testicular infections are also curable, but do not require surgery.
• The most common symptom of testicular torsion are excruciating pain in the affected testicle. In contrast, this is not found in testicle infections. They usually present with signs and symptoms of testicular swelling, redness, pain and tenderness of the testicles. Testicular torsion may also have symptoms of abdominal pain, fever, nausea and vomiting. Other symptoms related to testicular infections share some symptoms that include nausea, fever, fatigue, and pain (usually with urination).
• A factor that increases the risk of a male developing testicular torsion is an anatomic abnormality term “bell clapper deformity” that allows spermatic cord to twist more easily. In contrast, there are many known causes of testicle infections; for example, mumps virus, coxsackievirus, sexually transmitted diseases (mainly bacterial like Neisseria and/or Treponema), E. coli, Staphylococcus, Streptococcus and other species of bacteria.
• Testicular torsion treatment is radically different from treatment of testicle infections. For example, the standard treatment is emergency surgery, usually by a urologic surgeon, who will then suture both testicles to the scrotum (orchiopexy) to prevent any further twisting. Treatment of testicular infections depends on the underlying cause of the infection (for example, viral caused infections are usually not treated, but bacterial caused that are treated with appropriate antibiotics). However, both testicular torsion and testicular infections need to be followed up by your physician.
• The prognosis for testicular torsion is good with cures possible, depending on how quickly the testicle is untwisted. Like testicular torsion, testicular infections, in general, have a good outcome or cure. However, a complication common to both problems is that both may cause a reduction in fertility, especially in torsion patients that have had unsuccessful, delayed, or no testicular surgery that results in the loss of a testicle.

• Testicular torsion is a surgical emergency that may result in the loss of the affected testicle if not treated promptly.
• This is a painful condition caused by the twisting of the spermatic cord, which causes a loss of blood flow to the testicle.
• Testicular tissue cannot survive without blood flow. Torsion is the most common cause of testicle loss in adolescent males.

• 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.

Testicular Torsion Symptoms

Testicular torsion is characterized by excruciating one-sided testicular pain, with sudden swelling. Since the cord structures twist (like the strings of a puppet), the testicle elevates as well. Patients may have nausea and vomiting. Patients may also have abdominal pain. There may be a history of previous testicular pain. Fever may also accompany the testicular pain.

Testicular torsion is seen most frequently in the 12-18-year-old age group, and most cases occur in men under 30 years of age. However, it can occur at any age, including newborns.

Testicle Infection Symptoms

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

• 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.

Testicular Torsion Causes

The cause of the majority of cases is the bell clapper deformity, an anatomic abnormality that is present in some males. This anatomical condition allows the spermatic cord to twist more easily, resulting in compromise of the blood supply to the testicle. This can occur spontaneously or may be associated with trauma. There is no way to detect this deformity. In significant number of men who have this anatomical abnormality will have it in both testicles.

Testicle Infection Causes

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.

Testicular Torsion Treatment

The only treatment for testicular torsion is surgery. On rare occasions, a physician may be able to manually untwist the testicle, but this is not common. The importance of having testicular pain evaluated immediately cannot be overemphasized.

Care at home is inappropriate and will only result in the loss of the testicle.

If your doctor suspects torsion, a urologist will be notified. Depending on your history and physical, you may either be brought to the operating room or you may have imaging done.

In the emergency room, the patient with testicular torsion will probably receive a narcotic such as morphine for pain relief.

Testicular Torsion Surgery

The goal of surgery is to salvage the testicle. If the testicle cannot be salvaged, the testicle is removed (a procedure known as orchiectomy). If the testicle is detorsed successfully, it will be sutured within the scrotum so that it can no longer twist (called orchiopexy). The other testicle will also undergo the same fixation to the scrotum.
Patients who have a nonviable testicle may return for the insertion of a prosthetic testicle. This will be done only after the urologists feels that healing from the surgery is complete.

Testicle Infection Treatment

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.

Testicular Torsion Prognosis

Fertility should be maintained even after the loss of one testicle. There will be no apparent changes noted physically besides the loss of the testicle. The surgeon will inform the patient as to when follow-up is needed. The orchiopexy should prevent further episodes of torsion.

Testicle Infection Prognosis

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.