Orchitis is inflammation of one or both testicles. It’s usually caused by viral or bacterial infections. The name “orchitis” comes from the ancient Greek word for testicle.
Orchitis is inflammation of one or both testicles. It’s usually caused by viral or bacterial infections. The name “orchitis” comes from the ancient Greek word for testicle.
Viral orchitis is often caused by the mumps virus, particularly in adolescent boys and adult men who have not been vaccinated.
Bacterial orchitis often develops when the infection spreads from a nearby structure called the epididymis, a long, coiled tube behind each testicle that helps store and mature sperm. It’s usually caused by sexually transmitted infections in young men and urinary tract infections in older individuals.
It’s very uncommon to develop orchitis alone. Orchiepididymitis is more common, or orchitis alongside epididymitis, inflammation of the epididymis. Because of this, it’s unclear exactly how common orchitis is. According to one estimate, more than 600,000 cases of testicle and epididymis inflammation are diagnosed in emergency departments each year in the United States. The condition accounted for 1 in every 144 outpatient visits among males ages 18 to 50.
Fortunately, most people with orchitis don’t develop any long-term complications, but a small number of people may have complications like testicular shrinkage or infertility.
Orchitis can cause signs and symptoms that vary in intensity from barely noticeable to severe.
Usually, the first symptom is the sudden onset of testicular pain. Pain may develop suddenly and typically affects one side (so you may notice your left testicle hurting, for example). It may spread through your whole scrotum, the sac around your testicles.
Pain can eventually radiate through your groin or lower abdomen.
Other changes to your testicle or testicles may include:
Swelling and enlargement
Tenderness
Redness
You may also experience other possible symptoms of orchitis, including:
Fever and chills
Nausea and vomiting
Painful urination (dysuria)
Frequent urination
Urethral discharge, particularly if the underlying cause is a sexually transmitted infection that has spread to the epididymis and the testicle
Blood in the semen (hematospermia)
Orchitis is most often caused by the mumps virus. Mumps used to be a very common childhood infection. Luckily, the introduction of the combined measles, mumps, and rubella (MMR) vaccine in the 1970s reduced the number of yearly mumps cases by more than 99 percent. However, since 2006, mumps cases and outbreaks have increased, including in people who are fully vaccinated.
Mumps symptoms usuallybegin as:
Fever
Malaise
Headache
Muscle aches and pain
Weight loss and loss of appetite
More than 70 percent of people with mumps develop parotitis, or swelling of the parotid salivary glands in their cheeks. This swelling usually occurs on both sides of the face and is often called “chipmunk cheeks” due to the puffy appearance it can cause.
Orchitis is the next most common mumps symptom. Pain in the testicle can develop up to seven days after swelling of the facial glands.
It’s important to seek medical attention promptly if you suspect you or your child has orchitis to prevent complications.
Most cases resolve without issues, especially when treated promptly, but delaying diagnosis and treatment can increase your risk of possible complications, such as:
Testicular atrophy (shrinking of the testicle)
Problems with fertility
Epididymitis, inflammation of the epididymis that usually occurs at the same time as orchitis
Reactive hydrocele, fluid accumulation inside your scrotum
If orchitis is caused by the mumps virus, it typically resolves on its own.
Orchitis is most commonly caused by viral or bacterial infections. Orchitis in boys is usually viral. Except for viruses, infections usually don’t start in or only affect the testicle, and orchitis mostly happens together with epididymitis.
The most common cause of acute viral orchitis is the mumps virus. Bacterial orchitis often occurs as a complication of epididymitis, which is inflammation of the epididymis, an organ joined to your testicle that stores sperm. In children, E. coli bacteria are a common cause of infection. Bacterial orchitis in adults typically develops due to sexually transmitted infections like:
Chlamydia
Gonorrhea
Syphilis
The combination of epididymitis and orchitis is often referred to as epididymo-orchitis.
In older men, bacterial orchitis may result from prostate or urinary tract infections caused by organisms such as:
Escherichia coli
Klebsiella pneumonia
Pseudomonas aeruginosa
Staphylococcus
Streptococcus
In people who are immunocompromised, there have also been cases of orchitis caused by fungal infections.
There have also been a few rare cases of orchitis occurring due to autoimmune conditions.
Although anybody can develop orchitis, some groups of people are at a higher risk. They include the following.
Vaccination status. There are two vaccines available for children aged 12 months to 12 years to protect against mumps. The MMR vaccine protects against measles, mumps, and rubella. The MMRV vaccine protects against these and chickenpox.
Sexual activity. People who are sexually active are at risk of contracting STIs that can cause epididymo-orchitis, such as chlamydia or gonorrhea. The risk is highest if you have multiple sexual partners and don’t use protection. Learn more about practicing safe sex.
Age. Young adult males tend to have higher rates of STIs than older men. This puts them at an increased risk of STI-related bacterial orchitis.
Epididymitis. Men with epididymitis often also have orchitis or are at risk of developing it.
Urinary tract infections or prostate infections. UTIs or prostate infections can spread to your testicles if left untreated. The risk is especially high if you have a urinary obstruction or use a catheter.
Recent urologic surgery or procedures. Procedures such as catheterization or cystoscopy can put you at risk of UTIs that can spread.
Congenital urinary tract abnormalities. Some men might be predisposed to developing urinary tract infections due to their specific internal anatomy.
Prolonged physical stress or poor immune function. Periods of excessive stress or lower immune health may make you more vulnerable to infections in general, including those that affect your testicles.
The first step for getting an orchitis diagnosis is visiting your primary healthcare provider. They will likely start the diagnostic process with:
A review of your medical history, to assess your recent infections, sexual history, urinary symptoms, and past urologic procedures.
A physical examination, to check for testicular swelling, tenderness, redness, and scrotal warmth. Your doctor may also feel around your pelvis to rule out other conditions that can cause similar symptoms.
A review of your symptoms, to see if you have characteristic symptoms of orchitis.
If further tests are needed to confirm your diagnosis or rule out other conditions, your doctor may perform or order:
Urinalysis and urine culture. These tests involve peeing into a cup so your sample can be analyzed in a lab. Medical professionals can use it to detect urinary tract infections or sexually transmitted pathogens. They can also examine what strand of bacteria might be causing your infection.
Scrotal ultrasound with color Doppler. This test helps doctors evaluate testicular blood flow and distinguishes orchitis from other serious problems like testicular torsion or an abscess. Testicular torsion is when the cord that attaches to your testicle becomes tangled. An abscess is a pocket of pus.
Blood tests. Blood tests may show elevated white blood cell count or confirm viral infections such as mumps.
Your primary healthcare provider may also refer you to a specialist in urology, called a urologist, for further evaluation.
The best treatment for orchitis depends on the underlying cause. Here are your options for viral, bacterial, and severe cases.
If you have mumps orchitis or orchitis caused by another viral infection, your doctor may recommend supportive care alone if your symptoms are mild. Options include:
Bed rest and limited physical activity.
Scrotal elevation (keeping the scrotum elevated) to reduce discomfort.
Cold packs applied to your scrotum periodically.
Pain relief with over-the-counter anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs (like ibuprofen) or acetaminophen.
Antibiotics are not effective for viral infections, and your doctor won’t prescribe them for viral cases.
Along with the supportive treatment options above, the main treatment for bacterial orchitis or epididymo-orchitis is antibiotics. Antibiotics are medications specifically designed to kill or stop the replication of bacteria.
The type of antibiotic your doctor prescribes depends on the type of bacterial infection you have.
If your doctor suspects a sexually transmitted infection, they will likely give youthe medication ceftriaxone administered in an injection. They will also likely give you doxycycline to take orally twice per day for 10 to 14 days.
For other bacterial infections, your doctor may prescribe you one of a group of medications called fluoroquinolones for 10 to 14 days. Some examples include:
Ciprofloxacin
Ofloxacin
Levofloxacin
Most cases of orchitis don’t need hospitalization, but very serious cases might.
If you have severe complications, such as the formation of an abscess, you may need to receive antibiotics through an IV and stay in the hospital for one or more nights.
You may also need surgery to drain an abscess.
You can’t completely eliminate your risk of developing orchitis, but you can drastically reduce your odds by taking some basic precautions.
Here are some ways you can potentially help prevent orchitis:
Get vaccinated. Getting vaccinated for mumps can drastically reduce your risk of developing this infection.
Practice safe sex. Using condoms can reduce your risk of STIs. Getting tested regularly can also help prevent the spread of infections to others.
Treat STIs promptly. Early diagnosis and treatment can help prevent STIs from spreading to the testicles and other potential complications.
Manage urinary tract infections. UTIs aren’t as common in men as in women due to differences in anatomy. When UTIs do occur in males, they require immediate treatment to prevent complications such as orchitis.
Follow proper aftercare for urologic procedures. If you have urologic surgery, it’s important to follow your surgeon’s instructions to prevent infection after the procedure.
Boost immunity. You can support your immune health by maintaining a healthy lifestyle, such as eating a balanced diet, exercising regularly, and managing stress.
It’s also important to go to all your scheduled follow-up appointments with your healthcare provider if you’ve already been diagnosed with orchitis. Your doctor can check to make sure your infection is getting better and recommend other treatment options if it isn’t.
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