Orchitis: Symptoms, Causes & Treatment

Orchitis is an inflammation of one or both testicles that can cause symptoms like swelling, testicle pain, fever, malaise, or fatigue.

This condition most commonly occurs due to viral infections such as mumps, but it can also result from bacterial infections or trauma to the scrotum.

Treatment for orchitis should be guided by a urologist, who may recommend pain relievers, anti-inflammatory medications, or antibiotics to treat bacterial infections.

Common symptoms

The main symptoms of orchitis include:

• Sudden onset of testicle pain;

• Pain that may spread throughout the scrotum;

• Increased tenderness of the testicle to touch;

• Hardening of the testicle;

• Redness of the scrotum;

• Blood in the urine or semen;

• Fever or chills;

• General malaise;

• Fatigue or excessive tiredness.

In some cases, inflammation of the testicle may also involve the epididymis, a small duct that carries sperm to the urethra. When this occurs, it is called epididymo-orchitis.

When orchitis is related to mumps, symptoms may appear between 4 and 8 days after facial swelling begins. The sooner orchitis is identified, the higher the chances of complete recovery and the lower the risk of complications such as infertility.

Confirming a diagnosis

Orchitis is diagnosed by a urologist or primary care provider through an evaluation of symptoms, medical history, and a physical exam.

In most cases, additional tests are not required. However, the doctor may order a urinalysis or a urethral swab to check for sexually transmitted infections (STIs) and rule out a urinary tract infection.

If testicular torsion is suspected, a Doppler ultrasound may be recommended. In cases of mumps-related orchitis, a serum immunofluorescence antibody test may also be requested.

Possible causes

The most common causes of orchitis include:

• Viral, bacterial, or fungal infections;

• Trauma or injury to the scrotum;

• Sexually transmitted infections;

• Urinary tract infections.

These conditions lead to inflammation of the testicle, typically affecting only one side (unilateral), although both testicles (bilateral) can sometimes be involved.

Different types

There are several types of orchitis, classified according to how the inflammation develops and the underlying cause, such as infections or trauma:

1. Acute orchitis

Acute orchitis develops suddenly and is characterized by testicle pain and a feeling of heaviness in the testicles.

2. Chronic orchitis

Chronic orchitis is usually asymptomatic, though mild discomfort may be felt when the testicle is touched.

3. Viral orchitis

Viral orchitis is a complication that may occur in boys over the age of 10 or in young men who become infected with the mumps virus.

Other viruses that can cause orchitis include rubella, chickenpox (varicella), Coxsackie virus, echovirus, and cytomegalovirus (CMV).

4. Bacterial orchitis

Bacterial orchitis is often associated with urinary tract or prostate infections and may be caused by bacteria such as Escherichia coli (E. coli), Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus species, or Streptococcus species.

It can also result from sexually transmitted infections such as gonorrhea, chlamydia, or syphilis, and in these cases, it is often linked to epididymitis.

5. Fungal orchitis

Although rare, orchitis can also develop from fungal infections such as Candida albicans, particularly in people with weakened immune systems.

Treatment options

Treatment for orchitis should be managed by a urologist or primary care provider and varies depending on the underlying cause.

The main treatment approaches for orchitis include:

• Rest;

• Anti-inflammatory, antipyretic, or pain-relieving medications to ease symptoms (such as ibuprofen or acetaminophen);

• Warm or cold compresses to help relieve pain;

• Scrotal support to keep the scrotum elevated and still.

In general, once treatment begins, orchitis usually resolves within about 10 days.

For bacterial orchitis, the doctor will prescribe antibiotics based on the bacteria responsible for the infection. For viral orchitis, antibiotics are not needed.

In cases caused by sexually transmitted infections, the doctor will prescribe the most appropriate antibiotic according to the specific STI. It is also important that sexual partners receive treatment to prevent reinfection.

Can orchitis be cured?

Yes, orchitis can be cured and generally does not cause long-term effects when treated properly.

However, in some cases, complications may occur, such as testicular atrophy, abscess formation, reactive hydrocele, or infertility if both testicles are affected.