Orchitis

Disease Description (Causes and Symptoms)

• Definition: Orchitis is a condition in which inflammation develops in the testicular tissue. It may occur due to bacterial or viral causes.
• Causes and pathophysiology:
  • Bacterial: Spread retrogradely or through the bloodstream from adjacent organs such as the urinary tract, prostate, or epididymis. Common pathogens include Escherichia coli, staphylococci, and streptococci; rarely, Mycobacterium tuberculosis. Sexually transmitted infections (gonorrhea and chlamydia) are important causes in younger age groups.
  • Viral: Usually occurs through hematogenous spread, primarily after rubella (aseptic) or mumps.
  • Pathophysiology: Vasodilation, swelling, and pain occur due to inflammation; in severe cases, damage to and atrophy of the testicular tissue may develop.
• Main symptoms:
  • Local: Acute pain and swelling of one or both testicles (scrotal redness), with severe tenderness when pressed
  • Systemic: Fever and chills
  • Urinary and genitourinary symptoms: Cloudy urine, painful urination, urethral discharge (when accompanied by a sexually transmitted infection)
  • Findings on differential examination: Pain decreases when the scrotum is elevated (Prehn sign) (orchitis/epididymitis); in contrast, pain worsens with testicular torsion

Treatment Methods and Precautions

• Diagnostic principles: Differentiate orchitis from torsion and other conditions using clinical findings, urinalysis/urine culture, urethral/sexually transmitted infection testing, blood tests (CBC, CRP), and scrotal ultrasound (Doppler)
• Drug treatment:
  • When bacterial infection is suspected (empirical treatment considering age, sexual history, etc.)
    • Suspected sexually transmitted infection (usually under 35 years of age/with a history of sexual intercourse): A single intramuscular dose of ceftriaxone + oral doxycycline (10 days), etc. (according to domestic guidelines and susceptibility).
    • Suspected enteric bacteria (Escherichia coli) (older men, urinary tract dysfunction, etc.): A fluoroquinolone used to treat respiratory or urinary tract infections (e.g., levofloxacin) or another antibiotic (according to culture results).
  • For viral causes (e.g., mumps), antibiotics are ineffective — symptomatic treatment (see below).
  • The physician determines the choice of medication based on local resistance rates, patient allergies, clinical features, and culture results.
• Symptomatic treatment and conservative care:
  • Analgesics and anti-inflammatory drugs (NSAIDs), rest, scrotal support (underwear, taping, etc.), and cold compresses (do not apply ice directly; wrap it in a towel before applying).
  • If a severe abscess forms, surgical drainage or, rarely, excision (in cases of extensive tissue necrosis) may be necessary.
• Precautions and complications:
  • Delayed treatment may lead to testicular atrophy and chronic disease, and bilateral involvement increases the risk of infertility.
  • When associated with a sexually transmitted infection, sexual partners require treatment and testing.
  • When taking antibiotics, complete the medication as prescribed and check for allergies and drug interactions.
• Prevention:
  • MMR (measles, mumps, and rubella) vaccination is recommended to prevent mumps.
  • Some cases of bacterial orchitis may be prevented through safe sexual practices (condom use) and prevention of urinary tract infections.

Checklist Before an Outpatient Visit (Items to Bring · Test Records, etc.) — Including Example Questions

• Items to bring (when visiting the hospital)
  • A list of currently used medications (including prescription drugs, over-the-counter drugs, and supplements)
  • Copies of recent test results (urinalysis, urine culture, blood tests, ultrasound, etc.), if available
  • A record of when the symptoms began and how they have progressed (when they started, factors that worsen or relieve them, whether there is a fever, changes in urine appearance, etc.)
  • Sexual partner information (whether there has been recent sexual intercourse, whether condoms were used, and whether the partner has symptoms) — tell the doctor when necessary; anonymity will be ensured
  • History of allergies (medications, foods, latex, etc.)
• Examples of questions patients can prepare to ask at an outpatient visit:
  • "Are any of the medications I am currently taking incompatible with the treatment?"
  • "What tests will be performed (ultrasound/culture/blood tests, etc.)?"
  • "How long does it usually take for symptoms to disappear after treatment?"

Examples of General Questions to Ask the Doctor

• "How will you determine whether the cause of these symptoms is bacterial or viral?"
• "What is the name of the antibiotic I should take, how long is the expected treatment period, and what are its side effects?"
• "How high is the risk of infertility after treatment? If necessary, when should I have a semen analysis?"

Examples of Condition-Specific Questions

• "In my case (unilateral/bilateral involvement, age, underlying diseases, etc.), what additional tests or follow-up examinations are needed to reduce the risk of infertility?"
• "If symptoms do not improve with self-care such as scrotal cold compresses and support, when should I return or go to the emergency room?"