Orchitis: Causes, Symptoms, Diagnosis & Treatment Options

What is Orchitis?

Orchitis is a medical condition characterised by inflammation and swelling of one or both testicles, typically caused by a bacterial or viral infection. It may occur on its own or together with epididymitis, an inflammation of the tube behind the testicle, in a combined condition known as epididymo-orchitis. Recognising the signs of orchitis is important, as prompt diagnosis and treatment help relieve pain and prevent long-term complications, including testicular atrophy and reduced fertility. This article outlines the causes, symptoms, diagnostic steps and treatment options for orchitis.

What are the Causes of Orchitis?

Orchitis causes can be categorised into infectious and non-infectious types. Understanding the root cause is fundamental to determining the most effective course of treatment.

Infectious Causes

Infections are the most common reason for orchitis. These can be either viral or bacterial.

• Viral Orchitis: The most well-known viral cause of orchitis is the mumps virus. Mumps orchitis typically develops four to seven days after swelling of the salivary glands begins.
  About one in four males infected with mumps after puberty may develop orchitis. Other viruses, though less common, that can cause orchitis include Coxsackievirus, Echovirus and Epstein-Barr virus.
• Bacterial Orchitis: Bacterial infections are a more frequent cause of orchitis in sexually active men or men over the age of 45.
• Sexually Transmitted Infections (STIs): In younger, sexually active men, orchitis is often a complication of STIs. The most common culprits are Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhoea). These bacteria can travel from the urethra up the reproductive tract to infect the epididymis and testicles.
• Urinary Tract Infections (UTIs): In older men or those with urinary tract abnormalities, bacterial orchitis is more often linked to UTIs. Escherichia coli (E. coli) commonly causes bladder or prostate infections and can spread to the epididymis and testes.
• Non-Infectious Causes Although less common, orchitis can sometimes develop without an infection. These cases include:
• Trauma: A direct injury to the testicles can cause inflammation and swelling, leading to traumatic orchitis.
• Autoimmune Conditions: In rare instances, the body’s immune system may mistakenly attack the testicular tissue, causing autoimmune orchitis.
• Testicular Torsion: This includes the twisting of the spermatic cord that transfers blood to the scrotum. While not a direct cause of orchitis, reduced blood flow can lead to severe inflammation and damage if left untreated.

Orchitis Symptoms

The symptoms of orchitis can range from mild to severe and typically develop over a few days. The most prominent signs involve pain and swelling in the affected testicle.

• Common Symptoms
  • Testicular Pain and Tenderness: The pain can be sudden or gradual in onset and may range from dull to sharp, intense pain. The scrotum often feels heavy and is tender to the touch.
  • Swelling and Inflammation: The affected testicle (or both) may appear swollen, red and warm.
• Other Associated Symptoms

  In addition to testicular pain and swelling, individuals may experience a range of other symptoms, often indicating a systemic response to infection:

• Fever or chills
• Nausea or vomiting
• General feeling of illness (malaise) and fatigue
• Pain during urination (dysuria) or bowel movements
• Blood in semen (hematospermia)
• Penis discharge (more common in STI-related cases)

What Are the Treatment Options for Orchitis?

Orchitis treatment is focused on two main goals: treating the underlying cause and relieving symptoms. The specific approach depends on whether the orchitis is bacterial, viral or non-infectious.

• Bacterial Orchitis Treatment

  If a bacterial infection is diagnosed or suspected, a course of antibiotics is the primary treatment.

  • Antibiotic Therapy: The selection of an antibiotic depends on the likely pathogen. For STIs, guidelines from bodies like the British Association for Sexual Health and HIV (BASHH) recommend a combination of antibiotics like ceftriaxone and doxycycline to cover both gonorrhoea and chlamydia. For orchitis caused by a UTI, another antibiotic, like a fluoroquinolone, may be prescribed. It is important to complete the entire course of antibiotics, even if you start to feel better, to ensure the infection is fully removed.
  • Partner Notification: If the cause is an STI, sexual partners must also be notified and tested to prevent reinfection and further spread.
• Viral Orchitis Treatment There is no specific medication to cure viral orchitis, such as that caused by the mumps virus. Treatment is therefore supportive and aimed at relieving symptoms until the virus runs its course.
• Supportive Care This includes:
• Rest: Lying down and avoiding strenuous activity.
• Scrotal Support: Elevating the scrotum with a rolled-up towel or wearing an athletic supporter can help ease discomfort.
• Ice Packs: Applying an ice pack wrapped in a cloth to the scrotum for 15-20 minutes can help reduce swelling and pain.
• Pain Relief: Over-the-counter pain medications like ibuprofen.

Conclusion

Orchitis is characterised by painful swelling of the testicles, often caused by viral infections like mumps or bacterial infections like STIs and UTIs. Its primary symptoms are pain, swelling, and tenderness in the scrotum, often accompanied by fever and a general feeling of being unwell. It is important to seek prompt medical attention if you experience any of these symptoms.

A swift and accurate diagnosis is essential not only to initiate the correct treatment but also to rule out time-sensitive emergencies such as testicular torsion. Taking proactive steps, such as getting vaccinated against mumps and practising safe sex, can significantly reduce your risk of developing this painful condition.