Posts Tagged ‘scrotal swelling’

Orchitis-A Royal Pain In the Nutt

June 13, 2012

Orchitis is a painful inflammation of the testicle usually caused by a bacterial or a viral infection.  The most common virus that causes orchitis is mumps. It most often occurs in boys after puberty. Orchitis usually develops 4 – 6 days after the mumps begins. Because of childhood vaccinations, mumps is now rare in the United States.

Orchitis may also occur along with infections of the prostate or epididymis, which is the gland behind the testicle that is responsible for sperm maturation.  Orchitis may be caused by sexually transmitted diseases (STD), such as gonorrhea or chlamydia. The rate of sexually transmitted orchitis or epididymitis is higher in men ages 19 – 35.

Risk factors for sexually transmitted orchitis include: High-risk sexual behaviors, multiple sexual partners, personal history of gonorrhea or another STD, having a sexual partner with a diagnosed STD or having a urinary tract infection. 

Risk factors for orchitis not due to an STD include: Being older than age 45, long-term use of a Foley catheter (a tube used to drain the urine from the bladder to the outside of the body), surgery of the urinary tract such as a prostate or bladder operation. 

Symptoms of orchitis

The symptoms of orchitis include: Blood in the semen, a clear or yellow discharge from penis, fever, groin pain, painful ejaculation, Pain with intercourse or ejaculation, pain with urination, scrotal swelling, tender, swollen groin area on affected side, tender, swollen, heavy feeling in the testicle, and testicle pain that is made worse by a bowel movement or straining.

Signs and tests

A physical examination may show: an enlarged or tender prostate gland, tender and enlarged lymph nodes in the groin (inguinal) area on the affected side, and usually a tender and enlarged testicle on the affected side.

Tests may include:  Complete blood count (CBC) which usually shows an elevated white blood cell count, a esticular ultrasound, tests to screen for STDs, and a urinalysis and a urine culture (clean catch).


Treatments may include:  Antibiotics — if the infection is caused by bacteria (in the case of gonorrhea or chlamydia, sexual partners must also be treated), anti-inflammatory medications such as ibuprofen, pain medications, and bed rest with the scrotum elevated and ice packs applied to the affected area.

Expectations (prognosis)

Getting the right diagnosis and treatment for orchitis caused by bacteria can usually preserve the normal testicle function.

If the testicle does not completely return to normal after treatment, further testing to rule out testicular cancer should be done.  Usually this can be done with the scrotal ultrasound. 

Mumps orchitis cannot be treated, and the outcome can vary. Men who have had mumps orchitis can become sterile if the condition affects both testicles.


Some boys who get orchitis caused by mumps will have shrinking of the testicles (testicular atrophy).  Orchitis may also cause infertility.  Other potential complications include:  Chronic epididymitis, death of testicle tissue (testicular infarction) and scrotal abscess.

Acute pain in the scrotum or testicles can be caused by twisting of the testicular blood vessels (torsion), which is a surgical emergency. If you have sudden pain in the scrotum or testicles, get immediate medical attention.

Calling your health care provider

All testicle abnormalities should be medically evaluated. Call your physician or go to the nearest emergency room if you experience sudden pain in the testicle.


Getting vaccinated against mumps will prevent mumps-associated orchitis. Safer sex behaviors, such as having only one partner at a time (monogamy) and condom use, will decrease the chance of developing orchitis as a result of a sexually transmitted disease.

Bottom Line: Orchitis is usually caused by an infection and prompt treatment is required in order to save the testicle.  Call your physician or go to the emergency room for evaluation and treatment.