Orchitis and Epididymitis

Symptoms and treatment

Orchitis (inflammation of the testicle) on its own is a relatively rare condition. It most commonly occurs in childhood as a complication of mumps, and in adults it typically develops as an extension of epididymitis (inflammation of the epididymis). The most common sign is a sudden swelling and hardening of the affected testicle. The affected side of the scrotum is usually very tender to the touch, the skin appears taut and red, and pain may radiate into the groin or lower abdomen. A fever is also common. Both epididymitis and orchitis are often accompanied by pain during ejaculation and blood in the semen. Blood may also appear in the urine. In more complicated cases, the inflammation can affect sperm production and reduce fertility.

Who is at risk?

Epididymitis, and orchitis as its extension, is most commonly caused by sexually transmitted bacteria. The highest-risk group is therefore sexually active men between the ages of 15 and 35 with multiple partners. In older men, the infection is more often caused by bacteria present in the urinary tract, which multiply in the urine when the bladder does not empty fully. Any mechanical procedure involving the urinary tract, such as catheterisation, also carries a risk of triggering an infection.

Orchitis as a complication of mumps is viral in origin and occurs almost exclusively in childhood.

Examination and diagnosis

The examination begins with a physical assessment of the scrotum, combined with a rectal examination of the prostate to help us determine the full extent of the condition and identify any complications if the prostate is also affected. An ultrasound of the scrotum helps rule out other conditions, in particular testicular torsion (twisting of the testicle within the scrotum). The diagnosis is then confirmed by urine and blood analysis.

Treatment

Most cases of epididymitis and orchitis can be treated with antibiotics. The length of treatment depends on the severity of the inflammation and the client's overall condition. In more severe or painful cases, we may recommend hospitalisation with intravenous antibiotic administration. Rest is important even for clients recovering at home, and cooling the affected area with ice can also help. Staying well hydrated is essential to the successful treatment of any inflammation, including epididymitis and orchitis. Severe pain can also be temporarily relieved with a local anaesthetic injection into the spermatic cord.

In cases where the inflammation cannot be resolved with medication, surgical removal of the affected testicle or epididymis may become necessary. As the testicles are a paired organ, removal of one does not have a significant impact on sexual activity or fertility.