ORCHITIS – Causes, Risk Factors, Clinical Manifestations, Diagnostic Evaluations and Treatment
Orchitis or orchiditis is a condition of the testes involving inflammation. It can also involve swelling and frequent infection. Orchitis is inflammation of 1 or both testicles in men, usually caused by an infection. Orchitis can result from the spread of bacteria through the blood from other locations in body. It also can be a progression of epididymitis, an infection of the tube that carries semen out of the testicles. This is called epididymo-orchitis.
CAUSES
Orchitis can be either bacterial or viral.
Bacterial orchitis: Most often, bacterial orchitis is the result of epididymitis, an inflammation of the coiled tube that connects the vas deferens and the testicle. The vas deferens carries sperm from 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 a sexually transmitted disease (STD), particularly gonorrhea or Chlamydia. Other causes of infection may be related to having been born with abnormalities in urinary tract or having had a catheter or medical instruments inserted into 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.
OTHER TYPES
- Idiopathic orchitis – of unknown causes (maybe autoimmune)
- Autoimmune orchitis
- Secondary orchitis – caused by an underlying condition
- Orchitis vasiolosa – related to small pox
- Epididymo-orchitis – inflammation of testis and epididymis
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
- Having recurring urinary tract infections
- Long-term use of a Foley catheter
- Having surgery that involves the genitals or urinary tract (genitourinary surgery)
- Being born with an abnormality in the urinary tract (congenital)
High-risk sexual behaviors that can lead to STDs also put person 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 gonorrhea or other STD
CLINICAL MANIFESTATIONS
Swelling and pain are the most common signs and symptoms of orchitis. Orchitis symptoms usually develop suddenly. Orchitis symptoms may include:
- Testicular swelling on one or both sides
- Testicle pain ranging from mild to severe
- Tenderness in one or both testicles, which may last for weeks
- Nausea
- Fever discharge from penis
- Blood in the semen
- Hematuria (blood in the urine)
- Severe testes pain and groin pain
- Pain with intercourse or ejaculation
- Pain with urination (dysuria)
- Swollen testes and often the inguinal lymph nodes on the affected side
- Epididymis inflammation
- Tender, swollen groin area on affected side
DIAGNOSTIC EVALUATIONS
Doctor will do a physical exam, which may reveal enlarged lymph nodes in groin, enlarged or tender prostate gland and an enlarged testicle on the affected side; both may be tender to the touch. Doctor 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 doctor might order to determine the presence of an STD and to rule out the possibility of testicular torsion, which requires immediate treatment, include:
- Complete blood count (CBC)
- Testicular ultrasound
- STD screening: tests to screen for Chlamydia and gonorrhea (urethral smear)
- Urinalysis
- Urine culture (clean catch)
- Nuclear scan of the testicles
TREATMENT
Treatment depends on the course of orchitis
Treating viral orchitis: treatment for viral orchitis, the type associated with mumps, is aimed at relieving symptoms. Doctor may prescribe pain medication, non-steroidal anti-inflammatory drugs, and recommend bed rest, elevating scrotum and applying cold packs.
Over-the-counter non-steroidal anti-inflammatory drugs such as ibuprofen (advil or motrin, for example) or naproxen (aleve) and acetaminophen (Tylenol) may help with pain. Elevating scrotum with snug-fitting briefs or an athletic supporter can increase comfort. Apply ice packs. 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 the swelling (and pain) down.
Treating bacterial orchitis: in addition to steps to relieve discomfort, bacterial orchitis and epidiymo-orchitis require antibiotic treatment. If the cause of the infection is an STD, 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 doctor is aware of any other medications you’re taking or any allergies you have.
Be sure to take the entire course of antibiotics recommended by doctor. Even if symptoms clear up sooner, take all antibiotics to ensure that the infection is gone.
ORCHITIS – Causes, Risk Factors, Clinical Manifestations, Diagnostic Evaluations and Treatment