Epididymitis-orchitis is an inflammatory condition affecting the testicles (orchitis) and epididymis (epididymitis), key structures in the male reproductive system. This condition can be acute or chronic and is often associated with bacterial infections, sexually transmitted diseases (STDs), or other causes.
In this article, we'll take an in-depth look at what epididymo-orchitis is, its causes, symptoms, diagnosis, available treatments, and prevention. We'll also answer frequently asked questions about this condition.
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What is epididymo-orchitis?
Epididymitis-orchitis is a condition in which the simultaneous inflammation of the testicle (orchitis) and the epididymis (epididymitis), which is a coiled tube located at the back of the testicle that stores and also transports sperm. This inflammation can occur in two forms.
The first form is acute epididymitis-orchitis, which develops rapidly, usually within hours or days, with intense symptoms such as acute testicular pain, marked swelling, and fever. It is a much more common condition in young, sexually active men due to related sexually transmitted infections (STDs) such as chlamydia or gonorrhea.
On the other hand, chronic epididymitis-orchitis occurs when the condition persists for weeks or months, with recurrent episodes of mild to moderate testicular discomfort. This condition is often associated with recurrent urinary tract infections, urinary tract obstructions, or chronic prostatitis in older men.
The structures affected by epididymo-orchitis are the epididymis, which is the tube where sperm mature and are stored. Its inflammation (epididymitis) can obstruct the passage of sperm, affecting fertility, and the testicle, as testicular inflammation (orchitis) can damage the cells that produce sperm and testosterone, especially if not treated promptly.
Those at greatest risk of contracting epididymitis are men between the ages of 15 and 35, primarily due to the spread of sexually transmitted diseases; men over 40, due to urinary tract infections or prostate problems; and patients with urinary catheters or who have recently undergone urological surgery.
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Causes
Bacterial infections
The most common cause is bacterial infections, which can reach the epididymis and testicles through sexually transmitted diseases (STDs) such as Chlamydia trachomatis y Neisseria gonorrhoeae (which is common in sexually active young men); or due to urinary or prostate infections, with bacteria such as Escherichia coli (which is more common in older men or those with prostatic hyperplasia).
Viral infections
The mumps virus can cause orchitis in about 30% of unvaccinated men who contract the disease.
Other causes
There are other common causes such as trauma to the scrotal area, reflux of urine into the epididymis (due to intense physical exertion or urinary obstruction), or, in rare cases, tuberculosis.
Symptom
Symptoms vary depending on the cause (infectious or non-infectious) and severity, but the most characteristic may include testicular pain that is usually unilateral and may radiate to the groin or lower abdomen, scrotal swelling and redness with a feeling of heaviness, increased sensitivity to touch, thus making activities such as walking or sitting difficult, and the presence of fever and chills in acute infectious cases.
Symptoms associated with STIs include urethral discharge that may be white, yellow, or greenish, burning when urinating (dysuria), and pain during sexual intercourse or ejaculation.
Symptoms in non-infectious cases include mild but persistent pain, with intermittent swelling, related to physical exertion or urinary reflux.
It is also necessary to note the presence of serious signs that require urgent attention, such as a high fever of more than 38.5 °C, a scrotal abscess (with shiny skin and fluctuation to the touch), and nausea or vomiting, as they suggest possible testicular torsion, which constitutes a surgical emergency.
How is it diagnosed?
Diagnosing epididymitis-orchitis requires a thorough clinical evaluation to differentiate it from other conditions such as testicular torsion (which requires immediate surgery). Steps include a medical history and physical examination, assessing symptoms such as duration of pain, presence of fever, and history of STIs or urinary tract infections. A digital rectal examination may be performed if associated prostatitis is suspected, and palpation of the epididymis and testes may be performed to detect enlargement, lumps, or tenderness.
Laboratory tests are also performed, with urine analysis and urine culture, identifying bacteria such as E. coli o enterococcus. A PCR for STDs is performed to detect the Chlamydia trachomatis o Neisseria gonorrhoeaeA complete blood count is used to detect leukocytosis (increased white blood cells) in bacterial infections.
Imaging studies such as a scrotal Doppler ultrasound may be required to confirm inflammation of the epididymis or testicle, to rule out testicular torsion, or to detect abscesses or secondary hydroceles. An MRI may be useful in complex cases to assess the extent of the infection.
Risk factors and complications
Unprotected sex is the leading cause in people under 35, while benign prostatic hyperplasia (BPH) is a common cause in people over 50, as it obstructs urinary flow.
Other risk factors include the use of urinary catheters or urological procedures that introduce bacteria into the urinary tract, or immunosuppression in cases of diabetes or HIV, which increases the risk of serious infections.
There are potential complications such as a scrotal abscess, which is a localized infection with pus and may require surgical drainage, infertility due to obstruction of the epididymis or damage to the seminiferous tubules, testicular atrophy with tissue loss due to prolonged inflammation, chronic post-inflammatory pain in up to 15% of cases, and sepsis, in untreated infections, which can be a potentially fatal generalized infection.
Some differential diagnoses that may arise are testicular torsion, with sudden pain without fever, an incarcerated inguinal hernia, or testicular cancer, with a hard, painless mass.
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Treatment for epididymo-orchitis
The therapeutic approach depends on the underlying cause.
Drug treatment with antibiotics can be used for STIs and urinary tract infections. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to reduce pain and swelling, or pain relievers can be used if contraindicated.
General measures can be taken such as bed rest for 2 to 3 days, a scrotal support to relieve tension, and applying ice for 15 minutes every 2 hours if you are in the acute phase.
Surgical treatment may include drainage of abscesses if there is purulent collection and, in chronic cases that are resistant to treatment, epididymectomy.
Follow-up should include a re-evaluation in 48 to 72 hours to check for improvement, and evidence of cure (urine culture) should be performed once the antibiotic treatment has been completed.
Recovery and home care
Rest and elevation of the scrotum
The patient should wear tight-fitting underwear to keep the scrotum at a good level and thus reduce swelling.
cold application
The patient may use cold compresses to relieve pain.
Avoid sexual relations until the treatment is completed.
This helps prevent reinfection or the spread of STIs that can cause the condition to flare up.
Medical monitoring
Follow-up is absolutely necessary to confirm the real eradication of the infection.
Prevention of epididymo-orchitis
Condom use
Helps reduce the risk of contracting STIs.
Mumps vaccination
It can prevent mumps orchitis.
Treat urinary tract infections in time
Helps prevent bacterial spread and potential major long-term complications.
adequate hydration
It is necessary for the patient to always remain properly hydrated to prevent urinary tract infections.
Frequently Asked Questions (FAQs)
Is epididymitis-orchitis contagious?
Only if it is caused by a sexually transmitted disease such as chlamydia or gonorrhea.
How long does recovery last?
From 1 to 3 weeks if the appropriate treatment is followed.
Can epididymo-orchitis affect fertility?
Yes, if it causes epididymal obstruction or testicular atrophy.
Can you have orchitis without an STD?
Yes, due to urinary tract infections, mumps, or trauma.
What happens if it is not treated?
It can lead to abscesses, infertility or chronic pain.
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Conclusion
Epididymitis-orchitis is a treatable condition, but it requires prompt diagnosis and management to avoid possible complications. If you experience testicular pain, fever, or swelling, you should consult a urologist immediately. Prevention (with condom use, vaccination, and hygiene) is key to reducing risks.
If you have further questions, or think you may have epididymo-orchitis, don't hesitate to consult a specialist, as your health should always be paramount.
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