orchitis

Orchitis is the inflammation of one or both testes. It can occur as an isolated testicular inflammation or as part of epididymo-orchitis when the epididymis is involved. The condition often presents with testicular swelling and tenderness, fever, and malaise. Bilateral involvement is more common in mumps-related cases.

Causes and classification

Acute orchitis is most often viral, notably due to mumps in younger patients, or bacterial, typically from sexually transmitted infections in sexually active men or from ascending urinary tract infections in older men. Less common causes include trauma, autoimmune inflammatory disease, or granulomatous conditions. Chronic orchitis is less well defined and may be due to persistent infection, autoimmune processes, or inflammatory conditions. It is important to distinguish orchitis from other causes of acute scrotal pain, particularly testicular torsion.

Diagnosis

Evaluation begins with history and physical examination, with urgent assessment if torsion cannot be excluded. Scrotal ultrasound with Doppler is commonly used to assess blood flow and differentiate epididymo-orchitis from other conditions. Urinalysis and urine culture help identify urinary tract or sexually transmitted pathogen involvement. Testing for Neisseria gonorrhoeae and Chlamydia trachomatis is typically performed in younger, sexually active patients, while serology for mumps may be considered if appropriate.

Management

Treatment depends on the underlying cause. Bacterial epididymo-orchitis is managed with empiric antibiotics targeted at likely pathogens (for example, coverage for gonorrhea and chlamydia in younger patients and enteric organisms in older patients), along with analgesia and scrotal support. Mumps (viral) orchitis is generally managed with supportive care. Avoiding strenuous activity and ensuring proper hydration are advised. Hospitalization may be required for severe cases or complications.

Prognosis and complications

Most patients recover with appropriate treatment. Complications can include testicular atrophy, infertility (especially with bilateral infection or delayed treatment), chronic pain, or abscess formation.

Prevention

Prevention focuses on vaccination against mumps, safe sex practices, and prompt treatment of urinary tract infections to reduce the risk of ascending infection.