Orchitis is inflammation of the testis. The most common cause is a complication of infection with the mumps virus.
The commonest cause of orchitis in young children and adolescents is viral:
- Mumps is the commonest virus infection,
- Coxsackie virus,
- Echovirus, or
Bacterial infection with Brucella is not as common.
Orchitis may also be part of sexually transmitted diseases (STD) such as gonorrhoea.
Mumps is normally a childhood infection. Mumps virus is spread by (respiratory) droplets, direct contact or by contaminated environmental objects (fomites). There is a long incubation period of up to three weeks before classic symptoms appear, such as headache, fever, muscle aches, pain and swelling of the salivary glands.
Some adults with mumps have only a mild illness. However, in those with symptoms, these may be far more severe than in children, and orchitis is the most common complication, affecting up to 38 percent of men.
Symptoms of orchitis are:
- Sudden high fever - up to 42°C,
- Severe pain in the testes,
- Swelling and redness of the scrotum,
- 30 percent involve both testes, and
- Dysuria, penile discharge and lymph gland swelling, associated with STDs.
The diagnosis of mumps is clinical, and is simple when parotid gland involvement (parotitis) is obvious.
Without parotitis, blood tests may be needed to make the diagnosis, and these may show:
- Lowered white cell count,
- Predominance of lymphocytes,
- Raised serum amylase,
- Mumps antibodies - early antibodies indicating current infection, late antibodies indicating previous infection (meaning that the present symptoms are more likely not to be due to mumps).
There is no specific treatment for mumps, but symptomatic treatment, for instance for fever, is always indicated.
Specific treatment for orchitis is mainly symptomatic:
- Bed rest,
- Anti-inflammatories - non-steroidals are favoured,
- Support for the affected testes, and
- Ice packs.
Complications and outcome of orchitis
Testicular atrophy and Infertility has been recorded in up to 50 percent of men with previous mumps orchitis, with 13 percent having only impaired fertility. Involvement of both testes increases the risk of total fertility.
Testis cancer : this link has not been supported, and is regarded as speculative.
The only successful prevention of mumps orchitis is immunisation during childhood against this highly infectious disease.
(Dr A G Hall)