Orchitis – Introduction, Causes, Symptoms and Diagnosis.

Introduction

Orchitis is an inflammatory disorder occurring in one or both testicles of males, widely caused by various types of bacterial and viral infections. It is a type of infection may also be a progression of epididymitis, an infection with the tube that carries semen from the testicles. This condition is called epididymo-orchitis. It may also be caused by sexually transmitted infections such as chlamydia and gonorrhea. In children with this disorder is generally caused by the infection with mumps virus.

Types of orchitis

There are two types of orchitis as follows:

Acute orchitis

• Acute orchitis always occurs as a secondary disease or complication of cystitis, urethritis, benign prostatic hyperplasia (BPH), prostatitis and other reproductive diseases. It is often caused by urinary infection commonly in young adults and kids.
• The symptoms of Acute orchitis are sudden fever and chill, pain in the scrotum, swelling, redness, tense skin, frequent urinating, hydrocele in the testis, and pain of touch.

Chronic orchitis

• A chronic orchitis is a severe form of acute orchitis which cannot be alleviated for a long time. The disease conditions that often lead to chronic orchitis is syphilis of the testis, and also the trauma of the testis.
• Signs and symptoms include hard and enlarged testis, hard sperm duct and testis that do not stick to skin.

Epidemiology

The prevalence of those situations in isolation is uncommon, with epididymitis and orchitis commonly going on together. Approximately 20% of prepubertal sufferers (extra younger than 10 years) with mumps broaden orchitis. Unilateral testicular atrophy takes vicinity in 60% of patients with this disorder. Sterility has been hardly ever a final result of unilateral orchitis.

In the US, it is anticipated that there are 600,000 instances of this situation every year, taking vicinity most typically within the 19-35-one year-vintage age group. The perfect prevalence in Australia isn’t always identified.

History

The orchitis was first coined and described by Hippocrates in the 5th century. The term Orchitis literal meaning is ‘testicle inflammation’ which is a Greek word for ‘Testicle’.

What causes orchitis?

The major causes are bacteria and viruses.

• The commonly available bacterial species include Escherichia coli, Staphylococcus, and Streptococcus. These bacteria initially cause epididymitis and finally lead to orchitis as well.
• Sexually active men aged 19-35 years, can be infected with bacteria that are responsible for sexually transmitted diseases such as syphilis, gonorrhea, and chlamydia.
• If the person is affected with mumps, they may have an infection of testis by the mumps virus. Mumps virus can also cause orchitis. This happens most commonly in young boy children.
• The common viral organisms which cause orchitis are coxsackievirus, cytomegalovirus ( the causative agent of infectious mononucleosis), echovirus, and varicella.
• The most cases of this disorder are caused by progression and spreading of the testis diseases such as epididymitis, prostate cancer, prostate gland/urinary tract infection.

Risk factors

• A person may be at risk if they are not being immunized against mumps
• If people older than 45 years get frequent urinary tract infections
• If an individual beyond 50 years have placed Foley catheter into the bladder for prolonged time
• Genitourinary surgery (A Surgery for urinary tract)
• Congenital urinary tract disorders
• Having multiple sex partners
• Sex with a partner who had Sexually transmitted disease (STD)
• An unprotected sex and promiscuous sexual life
• If you have a history of STD’S
• Anal intercourse is also a major risk of infection with pathogens
• Untreated Urethritis and prostatitis may also pose a risk
• Bladder obstruction due to enlarged prostate and urethral abnormality

Symptoms

Symptoms may range from mild to severe. Inflammation may occur in one or both the testicles. The common primary symptoms are pain and swelling or the symptoms may appear more gradually. Symptoms that may include such as follows

• Body aches
• Pain when urinating (dysuria)
• Testicular swelling in one or both testicles
• Testicular redness
• Testicular pain and tenderness, which may last for weeks
• Fever and chills
• Headache
• Nausea
• Malaise and fatigue
• Bleeding in semen
• Abnormal discharge
• Enlarged prostate

Symptoms of orchitis

 Complications of Orchitis

Complication includes:

• Testicular atrophy
• Scrotal abscess (The infected tissue fills with pus)
• Repeated epididymitis
• Infertility

Diagnosis and test

Your doctor may start with a physical examination to check for enlarged lymph nodes in the groin area and enlarged testicles in the affected area. Your doctor may do a rectal examination to check tenderness or prostate enlargement.

Other laboratory tests and imaging tests are undertaken to evaluate other medical conditions which may present with similar symptoms:

Nuclear scan of testicles: the radioactive tracer is discharged into your blood. Then the scanner will scan the blood flow to the testicles which indicates torsion.

Ultrasound: Ultrasound imaging can rule out testicular torsions. Ultrasound with color Doppler can find the blood flow to the testicles. If the blood flow is lower than normal, then it indicates testicular torsion. If the blood flow is higher than normal then it will help to confirm the diagnosis.

Urine test: urine sample is taken and it is analyzed to find any abnormalities, appearance or content and to find which bacteria are the reason for infection.

STI (Sexually Transmitted Infection) screening: Discharge from the urethra is taken from the end of the penis. The sample is investigated in the laboratory for chlamydia and gonorrhea.

Treatment and medications

Treating bacterial orchitis

Antibiotics are required to treat bacterial orchitis. If it is caused by STI then your sexual partner also should go for diagnosis and treatment.

A patient should take the entire course of antibiotic which is prescribed by the doctor. It may take several weeks to get disappear from orchitis symptoms. Resting, supporting scrotum, ice packs and having pain medications may reduce the pain.

Antibiotics are prescribed based on the patient age and causes of the bacterial infection. Some of the common antibiotic which is used as follows:

• Ceftriaxone (Rocephin)
• Doxycycline (Vibramycin, Doryx)
• Azithromycin (Zithromax)
• Ciprofloxacin (Cipro)

Treating viral orchitis

If the orchitis is caused by a virus then it should not be treated with antibiotics. Treatment for relieving symptoms of viral orchitis, your doctor may advise

• Nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others)
• Bed rest and elevating your scrotum
• Cold packs

Although viral orchitis takes several weeks for disappearing symptoms, most people with viral orchitis will feel better after 10 days of treatment.

Prevention of Orchitis

• The most common cause of this disorder is a sexually transmitted infection. So practice safe sex by using condoms to reduce the extent of sexually transmitted diseases
• Immunise against mumps is the most common cause of viral orchitis
• Men’s above 50 years of age should be examined for prostate gland during their physical examination
• Inflammation and prevention may also be prevented by reducing the use of urinary catheterization