Definition

Orchitis is inflammation of the testicles that may occur in one or both testicles. It can cause pain and may affect fertility.

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Causes

Orchitis is often caused by an infection from:

• Viruses—The most common virus is mumps.
• Bacteria, such as those found in:
  • Epididymitis, which is usually caused by sexually transmitted infections (STIs). The epididymis is a long tube on the surface of the testicle that carries sperm from the testicle to the vas deferens.
  • Urinary tract infections
  • Tuberculosis
• Autoimmune diseases, such as Henoch-Schonlein purpura
• An inflammatory reaction following a bacterial infection somewhere else in the body

In some cases, the cause may be unknown.

Risk Factors

Factors that may increase your chances of orchitis include:

• A history of epididymitis or other STIs
• History of rubella (German measles)
• Never having measles, mumps, rubella (MMR) vaccine
• Long-term urinary catheter use
• Structural defects
• History of recurrent urinary tract infections
• A history of genital surgery
• Receptive anal intercourse

Behaviors that increase the risk of STIs also increase the risk of orchitis. High-risk behaviors include:

• Multiple sexual partners
• Sex without condoms
• Partner with a current STI

Symptoms

Orchitis causes testicular pain with swelling. Other symptoms include:

• Tenderness
• Feeling of heaviness in the scrotum
• Blood in the urine or semen
• Pain during urination, ejaculation, or sexual intercourse
• Generalized groin pain

Viruses and bacteria may also cause body-wide symptoms such as fatigue, fever, nausea, and headache.

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. A diagnosis may be made based on an exam of the testicles, scrotum, and groin area.

Testing is done to confirm the cause and to rule out testicular emergencies, especially testicular torsion. Signs of infections and the exact virus or bacteria involved can be determined with:

• Blood tests
• Urine tests
• Swab from the urethra to look for causes of infection

An ultrasound may be done to check the testicles and nearby structures for damage.

Treatment

Treatment depends on the cause of orchitis.

Medications

A viral infection will gradually pass on its own. Comfort measures, such as over-the-counter medications to reduce pain and fever, may be advised.

Antibiotics will be prescribed if a bacterial infection is present.

Surgery

If other treatments do not work or there is risk of damage, surgery may be needed. The goal of surgery is to reduce pain and prevent further damage.

Procedures include:

• Orchiectomy —Removal of the affected testicle.
• Epididymectomy—Removal of the epididymis of the affected testicle, while leaving the testicle in place.

Prevention

To help reduce your chance of orchitis:

• Get vaccinated with the MMR vaccine.
• Practice safe sex, including wearing a latex condom to prevent STIs.
• Get prompt treatment for any infections.