Orchitis and epididymitis

Reviewed by Mr John Macfarlane, consultant urological surgeon

The testicles and epididymis

Men have two testicles - one in each side of the scrotum - which produce sperm cells and hormones. The sperm is stored and allowed to mature in the epididymis (a convoluted glandular tube the top and side of each testicle) before it is conveyed to the spermatic ducts.

Although they are positioned close to each other anatomically and share a few common membranes, inflammation in the testicles and in the epididymis can have quite different symptoms.

What is orchitis?

Orchitis is an inflammation of testicle tissue. Mumps orchitis, a complication of the childhood viral disease, is the most typical example of complication in childhood; however, some men who get mumps with swelling of the parotid gland (the saliva-producing glands in the cheeks) will experience an inflammation in one or sometimes both testicles.

What does it feel like?

Approximately a week after the onset of mumps the following symptoms can occur:

pain in the scrotum, which will be more severe on walking

the scrotum may become hot and swollen

increased body temperature

the symptoms usually last for about a week.

What is the treatment for orchitis?

A week's bed rest.

Pain on walking can be eased using a suspensory bandage, which lifts the sore, swollen scrotum.

Painkillers can be used, but antibiotics are not recommended.

Those affected sustain permanent damage to their testicles, which may lead to decreased fertility in a minority of men.

An adult man whose child develops mumps should seek medical advice. An injection of gammaglobulin may decrease the risk of developing the infection in the testicles. However, the effectiveness of this treatment is still not proven. Today, all children are offered a vaccination against mumps when they are 12 to 15 months old.

What is epididymitis?

Inflammation of the epididymis is much more common than orchitis. Epididymitis usually arises as a complication of an urinary system infection, and is usually caused by a bacteria. In the past, gonorrhoea was the most common cause of epididymitis. Nowadays, most cases are probably caused by chlamydia. Nevertheless, in many cases no identifiable organism is found.

What does it feel like?

Symptoms may occur quite suddenly and can include:

a rise in body temperature accompanied by chills

a sore swelling of the epididymis

hot, reddish scrotal skin

occasionally, pain in the stomach accompanied by a sick feeling and vomiting.

Symptoms of a urinary tract irritation may also be present. These include burning pain when passing urine and an increased need to urinate. The inflammation can involve the testis, which is very painful and may be described as acute epididymo-orchitis.

How is the condition treated?

The infection and the symptoms may last for 8 to 10 days, during which the man should stay in bed and receive antibiotics.

After this, the temperature will return to normal, the pain will lessen and the swelling will slowly disappear. (Very occasionally, longer courses of antibiotics are required to fully clear any infection present.) However, up to six weeks may pass before the scrotum feels normal again. If the pain is severe, a GP may refer the patient to hospital for stronger painkillers or antibiotics by injection.

Follow-up investigation of the urinary system is often required if the infection recurs or is associated with urinary symptoms.

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