Epididymitis/Orchitis

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Pain Management Information for Patients
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Signs and Symptoms

Acute epididymitis, orchitis, and epididymo-orchitis caused by an infection usually results in severe, sudden pain in the testicular area. Pain often starts in the back of one testicle and can spread to the entire scrotal and pelvic area. Symptoms of the original infection (e.g., urinary tract infection, prostatitis), such as painful urination, urinary frequency, discharge from the urethra, and fever, also may be present. Scrotal pain and sensitivity often increase in severity and may lead to swelling, redness, and warmth.

Whenever severe testicular pain develops suddenly, it should be treated as a medical emergency until testicular torsion (blockage or reduction of blood flow to the testicle) is ruled out. Torsion is a rare but very serious condition.

Symptoms of mumps orchitis may include mild to severe testicular pain, swelling, tenderness, lower abdominal pain, fever, and chills. Initial symptoms of mumps, such as glandular swelling and pain in the jaw area, usually appear one week before orchitis symptoms.

Noninfectious cases and chronic cases of epididymitis and orchitis usually cause less severe pain that is limited to the scrotum, and do not cause swelling, redness, or warmth. Chronic cases usually develop gradually and last longer than six months.

Complications

Acute inflammation that recurs can lead to a chronic condition, resulting in chronic pain. In rare cases, epididymitis and mumps orchitis can cause infertility. Chronic cases, untreated cases, and cases involving both sides are more likely to result in infertility.

Tuberculous epididymitis and mumps orchitis can cause testicular atrophy (shrinkage), which may reduce testosterone production in the affected testicle. Testosterone levels are not affected in other cases. Severe cases may lead to an abscess (collection of pus), death of a testicle, or continuous draining through the skin, any of which may require surgery.

Diagnosis

To diagnose severe, sudden testicular pain, the first step is to rule out testicular torsion (a medical emergency), which often involves using ultrasound. If the ultrasound is inconclusive, other tests for torsion may be needed.

Tests for epididymitis may include urine and blood tests to look for signs of infection. Physical examination may reveal swollen lymph nodes in the groin and a tender or enlarged prostate. If a sexually transmitted infection is possible, the doctor may perform a urethral smear (a swab from inside the urethra) to test for chlamydia and gonorrhea. In boys who have not reached puberty, a complete urologic assessment may be performed to look for underlying urinary tract abnormalities.

Epididymitis/Orchitis, Signs and Symptoms, Diagnosis reprinted with permission from urologychannel.com
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