What Happens To Untreated Orchitis & When to Go to Doctor?

Testicular inflammation (orchitis) can occur on one side as well as on both sides. It leads to swelling and pain in the testicles and affects sperm production. The cause is mostly caused by viruses or bacteria. The course of the disease can be both acute (suddenly occurring) and chronic (permanent). Inflammation often affects the epididymis, which doctors then refer to as epi-didymo orchitis.(1)

What Happens To Untreated Orchitis?

Orchitis refers to those diseases that do not pose a threat to the life of the patient. However, if untreated, it can lead to unpleasant consequences for men, including reduced sexual potency to complete infertility. To prevent this, it is important to consult a doctor at its first sign.

When To Visit A Doctor For Orchitis?

If you think you have orchitis, or you notice inflammation, pain, redness, or swelling in the scrotum or testicles, contact your doctor right away. If you don’t see your doctor and your symptoms worsen go to the emergency department. Most cases of testicle inflammation caused by bacteria require immediate use of antibiotics.(2)

Symptoms Of Orchitis

The symptoms of orchitis differ depending on the cause of the infection. If the infection is caused by viruses, swelling and pain in the testicle area occur within a few hours. Touch, tight clothing and movements can also cause discomfort. The testicle may also become red.

Bacterial testicular inflammation also causes reddening and painful swelling of the affected testicle. Unlike a viral infection, the symptoms develop over several days. The epididymis is very often affected in this form of the disease.

Causes Of Orchitis

Most often the causative agents are viruses, but sometimes by bacterial inflammation are noted. These get into the testicles via the bloodstream or neighboring structures. Very rarely, testicular inflammation can also result from direct violence if, for example, the testicle is injured.

Viruses that can cause testicular inflammation include:

  • Epstein-Barr virus (causative agent of glandular fever)
  • Influenza virus (flu virus)
  • LCM virus (causative agent of lymphocytic choriomeningitis, meningitis that is transmitted by rodents)
  • Paramyxoviruses (causative agents of mumps, most common cause of testicular inflammation)
  • Varicella virus (causative agent of chickenpox)

The following bacterial diseases or pathogens can cause testicular inflammation:

  • Epididymitis
  • Especially in children: pneumococci (causative agent of pneumonia) and salmonella
  • Gonorrhea
  • Prostatitis (inflammation of the prostate)
  • Streptococcus infection (trigger of scarlet fever)
  • Syphilis
  • Urethritis (inflammation of the urethra)(3)

Diagnosis Of Orchitis

The inflammation can usually be determined relatively easily based on the external appearance of the testicle. A physical examination by the doctor often shows that the painful testicles are swollen and hard. Characteristically, the pain subsides as soon as the doctor raises the testicles.

Also, a blood test is carried out, which shows higher inflammation values in those affected. In some cases, it can be difficult to distinguish testicular inflammation from other possible diseases. Symptoms of epididymitis, testicular tumors or rotation of the testicles around the longitudinal axis (testicular torsion) can cause very similar symptoms. In this case, an ultrasound examination is indicated to be able to make a more precise diagnosis.(4)

Treatment Of Viral Orchitis

Therapy for orchitis caused by viruses includes measures to alleviate the symptoms. On the one hand, this includes bed rest; on the other hand, the testicles should be raised and cooled. Pain relievers or anti-inflammatory drugs can also be used to relieve discomfort.

Since mumps viruses are the most common trigger for inflammation of the testicles, is preventive vaccination against mumps recommended.(5)

Treatment Of Bacterial Orchitis

In the case of testicular inflammation caused by bacteria, the same measures as for the viral form are initially used to relieve symptoms. Also, antibiotics are usually necessary.

In rare cases, surgery may also be necessary if the testicles are swollen due to the inflammation or if purulent abscesses have formed. Infectious foci are then cut out during surgery to minimize the burden on the testicles.

Follow-Up For Orchitis

In most cases, testicular inflammation heals after about a week without further consequences. However, complications can sometimes occur. This occurs especially when the testicle is repeatedly inflamed or insufficient treatment is given.

The inflammation can then spread to the epididymis or form abscesses. Sperm production is usually impaired for a few months after testicular inflammation, but usually recovers.

References:

  1. Pilatz A, Fijak M, Wagenlehner F, Schuppe H. Orchitis. Der Urologe. Ausg. A. 2019;58(6):697-710.
  2. Dasu N, Khalid Y, Panuganti S, Daly S. Amiodarone induced epididymo-orchitis. Urology Case Reports. 2019;26:100929.
  3. Ip CCK, Tumali K, Hoh IM, Arunasalam A. Acute epididymo-orchitis from brucellosis melitensis in Australia. BMJ Case Reports CP. 2019;12(7):e230007.
  4. Goonewardene SS, Pietrzak P, Albala D. Diagnostic Pathway for Epididymo-Orchitis. Basic Urological Management: Springer; 2019:155-155.
  5. Bautista BF, Hernández AP, Rodríguez RO, Lucena LB, Madero JA. Endoscopic treatment of urethrodeferential reflux in children. Actas Urológicas Españolas (English Edition). 2018;42(2):133-136.

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