Orchitis: Overview and More - Verywell Health

Orchitis is the inflammation of one or both testicles. It is most often caused by a bacterial or viral infection, although the cause may be unknown. The inflammation can cause pain and swelling of the testicle, sometimes severe.

Orchitis may occur alongside the infection of the epididymis (the coiled tube that transports sperm from the testicle) or the prostate gland (the walnut-sized organ below the bladder that produces seminal fluid). If not treated appropriately, orchitis may lead to complications, including infertility.

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This article looks at the symptoms, complications, and causes of orchitis. It also walks you through how the condition is diagnosed, treated, and prevented and what to expect in terms of outcomes.

Symptoms

The symptoms of orchitis tend to develop suddenly and may be either limited to the testicles (aka testes) or extend deeper into the groin. When the epididymis is involved, the condition is referred to as epididymo-orchitis.

Depending on the severity and underlying cause, the signs and symptoms may include:

• Pain or tenderness in one or both testicles
• Visible swelling in one or both testicles
• Heaviness in one or both testicles
• Groin tenderness or pain
• Fever
• Pain with urination
• Pain with intercourse or ejaculation
• Discharge from the penis
• Blood in semen

Complications

If left untreated, orchitis can lead to potentially serious complications in some people. The inflammatory damage to the testicles or adjacent structures, like the epididymis, can sometimes be irreversible.

Possible complications of orchitis include:

• Scrotal abscess (a pocket of pus within the scrotum, the sac that holds the testicles)
• Testicular atrophy (shrinkage of the affected testicle)
• Testicular infarction (death of testicular tissue)
• Infertility (due to damage to the testicles and/or epididymis)

Recap

Pain and swelling of the testicles are the central features of orchitis. Depending on the underlying cause, there may also be fever, groin pain, pain with urination or sex, and a visible discharge from the penis. If left untreated, severe orchitis can lead to infertility.

Causes

Orchitis is most often caused by a bacterial or viral infection. It mostly affects adults but can ultimately affect people of any age who have testicles.

Orchitis can even affect younger kids due to childhood viral infections like mumps, rubella (German measles), or varicella (chickenpox). Mumps is by far the most common cause of orchitis in children, particularly those 14 and over. Mumps in adults with testicles can lead to sterility.

In adults, bacterial infections are the most common cause of orchitis (although there are some viral and fungal causes as well). These include:

Risk Factors

There are certain factors that can increase a person's risk of orchitis. The risk factors can differ by the type of infection involved.

Risks factors for orchitis associated with STIs include:

• Condomless sex
• Multiple sex partners
• Prior history of gonorrhea or other STIs
• Being between the ages of 19 and 35

Risk factors for orchitis not associated with STIs include:

Recap

Orchitis can affect adolescents, teens, young adults, and even younger children. In children, viral infections like mumps are the most common causes. In adults, bacterial infections, including STIs, account for most cases.

Diagnosis

The diagnosis of orchitis starts with a physical examination and a review of your symptoms and medical history. Lab and imaging tests can help pinpoint the exact cause of your condition.

Physical Exam

As part of the physical exam, the doctor will want to examine the testicles and urethra. The doctor will also palpate (gently touch and press) surrounding areas, including the groin, to check if there is any pain, tenderness, or symptoms like swollen lymph nodes.

To check whether there is prostatitis (prostate inflammation), the doctor will perform a digital rectal exam (DRE) in which a gloved, lubricated finger is inserted into the rectum to check the size of the prostate gland.

Lab and Imaging Tests

Blood and urine tests are standardly used in the diagnosis of orchitis. This not only helps pinpoint the cause of your symptoms but excludes other possibly serious concerns (like testicular cancer). Imaging tests can aid in the diagnosis or characterize the severity of your condition.

Among the lab and imaging tests commonly used to diagnose orchitis are:

Differential Diagnoses

Your doctor may also order tests to exclude potentially serious conditions with similar features. This is referred to as the differential diagnosis.

The conditions commonly investigated in the differential diagnosis for orchitis include:

• Testicular torsion (a medical emergency caused by an abnormal twisting of a testicle)
• Hydrocele (the build-up of fluid in the scrotum due to an injury or infection)
• Testicular cancer (diagnosed with ultrasound and the removal of the testicle)
• Prostate cancer (which can sometimes spread to the testicles)
• Retention of urine (when the bladder does not empty, putting you at risk for infection)

Recap

The diagnosis of orchitis may involve a physical exam, a review of your medical history and symptoms, various blood and urine tests, and an ultrasound of your testicles.

Treatment

The treatment of orchitis can vary by the underlying cause. Some mild cases require no treatment and will begin to ease in a couple of days. If the cause is a bacterial infection or an STI, treatment will be needed.

Treatment options for orchitis include:

Antibiotics are typically prescribed in a 10- to 14-day course. If an STI is involved, sexual partners will also need to be treated. Sex should be avoided until the infection is fully cleared and your doctor gives you the OK.

While recovering, avoid lifting heavy objects as this can cause pressure in the groin and increase pain. Move around as little as possible, and wear a jockstrap to help stabilize and support the scrotum.

Recap

The treatment of orchitis may include bed rest, scrotal support, ice packs, oral painkillers, anti-inflammatory drugs, and antibiotics if a bacterial infection (including a bacterial STI) is involved.

Prognosis

The majority of orchitis cases caused by a virus or treated with antibiotics will resolve without any further complications. There may still be swelling and tenderness after antibiotic therapy is completed, but a drop in your body temperature within the first three days is generally a good sign that the infection will clear.

The one exception is mumps orchitis for whom 50% of adults with penises will experience testicular shrinkage and an estimated 1 in 10 will experience a drop in sperm count. In rare cases, the drop may be significant enough to cause infertility.

Most cases of mumps orchitis will resolve within 10 days.

Recap

Most viral causes of orchitis or those treated with antibiotics will resolve with no complications. The only exception may be mumps orchitis for whom some adults will experience testicular shrinkage and a drop in their sperm count.

Prevention

As STIs are a major cause of orchitis, you can reduce the risk by practicing safer sex. This includes the consistent use of condoms and a reduction in your number of sex partners.

Mumps vaccination is also an important way to avoid orchitis. This is delivered in the form of the measles, mumps, and rubella (MMR) vaccine, which is recommended for all children and given in two doses. The MMR vaccine can also be given to adults born after 1957 in one or two doses. (It is presumed that people born before 1957 are immune to mumps.)

You can also reduce the risk of orchitis if you have an enlarged prostate. Benign prostatic hyperplasia (BPH) can be managed with medications like Flomax (tamsulosin) that relax the muscles of the prostate gland or others like Proscar (finasteride) that help shrink the gland itself.

Recap

The risk of orchitis can be reduced by practicing safer sex, getting vaccinated against mumps, and managing benign prostatic hyperplasia (BPH).

Summary

Orchitis is the inflammation of one or both testicles, mainly caused by a bacterial or viral infection. Symptoms include pain and swelling of the testicle as well as fever, groin pain, pain during sex, pain while urinating, and a visible discharge from the penis.

Orchitis can affect anyone who has testicles, including adults, teens, adolescents, and even younger children. Common causes include mumps, bacterial UTIs, bacterial prostate infections, and sexually transmitted infections like gonorrhea, chlamydia, or syphilis.

Orchitis can be treated with bed rest, scrotal support, ice application, anti-inflammatory drugs, oral pain relievers, and antibiotics. Most viral cases and those treated with antibiotics will resolve without any further complications.

If left untreated, severe orchitis can cause testicular shrinkage and infertility. Safer sex practices and mumps vaccination can significantly reduce the risk.

A Word From Verywell

As embarrassing as it may seem to talk with a doctor about swollen, painful testicles, don't let embarrassment get in the way of seeking a proper diagnosis. This includes the diagnosis and treatment of STIs. Even if acute symptoms clear, you may still sustain damage that can affect your ability to have children in the future.

Your symptoms may also be due to a more serious condition like testicular torsion or testicular cancer. Early diagnosis and treatment almost invariably improve the outcomes whatever the cause of your testicle pain.

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