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what is epididymo orchitis

Medically Reviewed by Dr Sravya, MBBS, MS 

Introduction

The male reproductive system plays a vital role in the process of reproduction. It has several important functions such as the production, maintenance, and transportation of male reproductive cells (sperm), and the sperm-containing fluid (semen), discharging sperm cells through the semen during ejaculation, and making and releasing male sex hormones, like testosterone. Some parts of the system are involved in urination.

epididymo orchitis

The male reproductive system is a complex unit made up of several organs, both internal and external. The external organs are the penis, scrotum, and testicles (testes). The internal organs or accessory organs are the epididymis, vas deferens, ejaculatory ducts, urethra, seminal vesicles, prostate gland, and the bulbourethral (Cowper’s) glands.

At times, infections or certain drugs can cause inflammation of these organs. One such inflammation is known as epididymo-orchitis.

Table of Contents

    1. What is epididymo-orchitis
    2. Causes
    3. Symptoms
    4. Diagnosis
    5. Treatment
    6. Complications
    7. Preventions

What Is epididymo-orchitis?

Epididymitis is the inflammation of the epididymis. The inflammation of one or both testicles is known as orchitis. When these two conditions are present together, the condition is called epididymo-orchitis.

About 1 in every 1000 males is affected by this condition. It is more common in males between 15-30 years of age and in males above 60 years of age. It is rare in young boys before puberty.

Causes of epididymo-orchitis

In pre-pubertal boys, the condition is seen rarely. Most commonly, it may be due to urine flowing backward into the epididymis.

In males above 15 years of age, it can occur due to several causes, such as –

1.Urine infections -

  • Bacteria such as E.coli present in the urine may travel to the epididymis and cause an infection.
  • It is more often seen in males above 35 years of age. This is because, with increasing age, there are higher chances of partial blockage of urine due to an enlarged prostate gland or narrow urethra. Blockage of urine makes them more susceptible to infections.

2.Sexually transmitted infections (STIs)

  • The most common cause in males who are sexually active is STIs.
  • The STIs in which it is seen frequently are chlamydia and gonorrhoea.

3.Mumps

  • The inflammation can happen in males who have mumps, as the virus can travel to the epididymis and testicles through the bloodstream..
  • This can be a causative factor in boys younger than 15 years as well.

4.Surgery

  • Rarely, it can be a complication of a prostate removal surgery.

5.Drugs -

  • It is a rare side-effect of the drug “Amiodarone” used for heart problems.

6.Other causes include

  • Tuberculosis
  • Brucellosis.
  • Insertion of catheters into the urethra
  • Schistosomiasis (a parasitic disease)
  • Injury to the groin area
  • It is a rare side-effect of the drug “Amiodarone” used for heart problems.

Sign and symptoms of epididymo-orchitis

Epididymo-orchitis is an acute condition. Thus, the symptoms develop very quickly, within a few days. Symptoms include –

  • Intense pain in the scrotum
  • Swelling of one or both testicles
  • Swelling of the epididymis
  • Enlargement of the scrotum
  • Swelling with fluid in the scrotum (hydrocele)
  • Swelling with fluid in the scrotum (hydrocele)

Some symptoms may be present due to the underlying cause, such as –

  • Pain and burning during urination, if inflammation is due to infections
  • Discharge from the penis, if epididymo-orchitis is caused due to STIs
  • Blood in the urine, if the urethra is infected
  • Fever, nausea, and a general feeling of illness that accompanies any infection

Diagnosis of epididymo-orchitis

If a patient presents with symptoms, the doctor will prescribe some tests to confirm the diagnosis, such as –

1.Physical examination -

  • The scrotum is palpated to check for changes in the epididymis and testicles due to inflammation. It is also checked for pain, swelling, and tenderness.

2.Urine test

  • The urine is tested for the presence of infection-causing bacteria
  • If symptoms associated with sexually transmitted infections are also seen, the urine is tested for the same. A swab from the penis may also be taken for this purpose.
  • Sexual partners of patients with symptoms should also be tested.

3.Blood test

  • A complete blood count will be conducted to check for the presence of infection or inflammation.

4.Tests to check the urethra and urinary bladder may be conducted to check for the presence of blocked urine.

5.Doppler ultrasonography may be conducted in some cases

Treatment of epididymo-orchitis

Epididymo-orchitis is a treatable condition. The treatment majorly depends on the underlying cause. The choice of treatment for epididymo-orchitis is antibiotic administration.

Antibiotics can treat inflammation caused due to STIs or other infections. However, antibiotics may not be helpful in cases caused due to viruses, such as mumps. In that case, antiviral medication is prescribed.

Antibiotics used for the treatment caused due to sexually transmitted infections are doxycycline, ceftriaxone, levofloxacin, ofloxacin, azithromycin, and erythromycin. Antibiotics must be taken only after consultation with a doctor. Never self-medicate.

Medications used for the treatment of epididymo-orchitis in prepubertal young males with infections due to internal bacteria are trimethoprim/sulfamethoxazole or amoxicillin/clavulanate.

In addition to medication, other measures can be taken to treat and manage epididymo-orchitis, such as

  • Limit physical activity
  • Ice pack application to the scrotum
  • Anti-inflammatory medication
  • Painkillers
  • Supportive underwear
  • In the case of STI, any form of sexual activity must be avoided till the treatment is complete.

Complications of epididymo-orchitis

Epididymo-orchitis is a fully curable condition. Therefore, complications related to it are rare. However, if left untreated for too long, some complications may develop. These include –

1.Pus may form and collect in the scrotum, causing an abscess to form. A minor surgical procedure is required to drain the abscess.

2.Ongoing inflammation may be seen.

3.Pain and swelling may become chronic and last for up to three months.

4.Fertility may be reduced due to shrinkage of the affected testicle(s). This is mostly seen when inflammation is due to mumps infection.

5.In severe cases, dead tissue may form in the testicles, causing gangrene. In such cases, the testicle has to be surgically removed.5

Prevention of epididymo-orchitis

One can take some measures to reduce the risk. Always using condoms during sex can prevent the transfer of bacteria causing sexually transmitted infections.

To prevent urinary infections due to blocked urine, it is best to avoid lifting very heavy things or doing rigorous physical activity.

Protection against mumps infection can be obtained by taking the mumps vaccine.