7 Common Orchitis Symptoms You Should Know About

Orchitis is a medical condition characterized by inflammation of one or both testicles, typically caused by bacterial or viral infections. This painful condition can affect men of any age, though it’s most commonly seen in males between 14 and 35 years old. The inflammation can develop suddenly and may lead to significant discomfort and complications if left untreated. Understanding the symptoms of orchitis is crucial for early detection and prompt medical attention, which can help prevent long-term damage to the reproductive system.

While orchitis can occur on its own, it often develops alongside epididymitis (inflammation of the epididymis) in a condition called epididymo-orchitis. The severity of symptoms can vary from person to person, ranging from mild discomfort to severe pain that interferes with daily activities. Recognizing these warning signs early can make a significant difference in treatment outcomes and recovery time.

1. Testicular Pain and Tenderness

The most prominent symptom of orchitis is pain in one or both testicles. This pain can range from a dull ache to sharp, intense discomfort that may worsen throughout the day. The affected testicle becomes extremely tender to touch, making even light contact uncomfortable or painful.

The pain associated with orchitis typically develops gradually over several hours or days, though in some cases it can appear suddenly. Many men describe the sensation as a heavy, throbbing pain that may radiate to the groin, lower abdomen, or inner thigh. The intensity of pain often increases with movement, physical activity, or during bowel movements. Some patients report that the pain becomes worse when sitting or standing for extended periods.

Key characteristics of testicular pain in orchitis:

• Usually affects one testicle, though both can be involved
• Pain may intensify during urination or ejaculation
• The affected area is highly sensitive to pressure or touch
• Pain may be accompanied by a feeling of heaviness in the scrotum

2. Scrotal Swelling and Enlargement

Swelling of the scrotum is another hallmark symptom of orchitis. The affected testicle typically becomes noticeably larger than normal, and the scrotal sac may appear puffy or distended. This swelling occurs due to inflammation and fluid accumulation in the tissue surrounding the testicle.

The degree of swelling can vary considerably between individuals. In mild cases, the enlargement might be barely noticeable, while in severe cases, the affected testicle can double or even triple in size. The swelling usually develops over a period of several hours to a few days and may be accompanied by a feeling of tightness or pressure in the scrotal area.

The swollen testicle may also feel firmer than usual when gently examined. In some cases, the entire scrotum becomes so swollen that it’s difficult to distinguish between the individual testicles. This swelling can make walking uncomfortable and may require the person to adjust their posture or gait to minimize discomfort.

3. Redness and Warmth of the Scrotum

Visible changes to the scrotal skin are common in orchitis. The skin over the affected testicle often becomes red or appears flushed, indicating inflammation and increased blood flow to the area. This redness may be localized to one side of the scrotum or spread across the entire scrotal sac.

Accompanying the redness, the scrotal skin typically feels warm or hot to the touch. This warmth is a direct result of the inflammatory process and increased blood circulation as the body attempts to fight the infection or inflammation. The temperature difference between the affected and unaffected side may be noticeable when comparing both sides of the scrotum.

In some instances, the scrotal skin may appear shiny or stretched due to the underlying swelling. The texture of the skin might also change, feeling smoother than normal or appearing taut. These visible symptoms can be concerning, but they are typical indicators of the inflammatory process occurring within the testicle.

4. Fever and Chills

Systemic symptoms such as fever are common when orchitis is caused by an infection. Body temperature may rise above 38°C (100.4°F), though the fever is typically low-grade in the early stages. The fever indicates that the body’s immune system is actively fighting the infection causing the testicular inflammation.

Along with fever, many patients experience chills, alternating periods of feeling cold and hot, and general discomfort associated with elevated body temperature. These symptoms may be accompanied by sweating, particularly at night, and a general sense of being unwell. The presence of fever suggests that the orchitis has an infectious origin, most commonly viral or bacterial.

Fever-related symptoms in orchitis may include:

• Temperature fluctuations throughout the day
• Night sweats that may require changing clothes or bedding
• Feeling alternately hot and cold despite room temperature remaining constant
• Increased heart rate accompanying the fever

5. Nausea and Vomiting

Gastrointestinal symptoms, particularly nausea and vomiting, can occur in cases of orchitis, especially when the pain is severe. These symptoms result from the body’s response to intense pain and inflammation in the testicular area. The connection between testicular pain and nausea is due to shared nerve pathways between the testicles and the gastrointestinal system.

The nausea associated with orchitis can range from mild queasiness to severe nausea that leads to vomiting. Some men report feeling nauseated throughout the day, while others experience waves of nausea that come and go. The nausea may be more pronounced during periods of increased testicular pain or when the affected testicle is touched or moved.

These gastrointestinal symptoms can contribute to overall discomfort and may lead to decreased appetite and reduced fluid intake, which can complicate the condition. It’s important to maintain adequate hydration even when experiencing nausea, as dehydration can worsen other symptoms and slow recovery.

6. Blood in Semen (Hematospermia)

Some men with orchitis may notice blood in their semen, a condition known as hematospermia. The semen may appear pink, red, or brown in color, depending on the amount of blood present and how recently bleeding occurred. This symptom can be alarming, but it’s a recognized complication of testicular inflammation.

The presence of blood in semen occurs when inflammation affects the small blood vessels in the testicles or the structures involved in semen production and transport. The bleeding is typically minor and resolves as the inflammation subsides with appropriate treatment. However, this symptom should always be reported to a healthcare provider, as it requires proper medical evaluation.

Not all men with orchitis will experience hematospermia, and its absence doesn’t rule out the condition. When it does occur, it may be noticed during ejaculation and can persist for several days or weeks, even as other symptoms begin to improve. The amount of blood is usually small and not medically dangerous, though it can be psychologically distressing.

7. Painful Urination and Urinary Symptoms

Discomfort or pain during urination, medically termed dysuria, is a common symptom when orchitis is caused by bacterial infection, particularly sexually transmitted infections. The pain may be felt as a burning or stinging sensation that occurs when urine passes through the urethra.

Additional urinary symptoms that may accompany orchitis include:

• Increased frequency of urination, with the need to urinate more often than usual
• Urgency, or the sudden, strong urge to urinate that’s difficult to postpone
• Blood in the urine (hematuria), which may make urine appear pink, red, or cola-colored
• Cloudy or foul-smelling urine indicating possible infection
• Difficulty starting urination or weak urine stream

These urinary symptoms occur because infections that cause orchitis often begin in the urinary tract or urethra and spread to the testicles through the reproductive system’s connected pathways. When orchitis occurs alongside a urinary tract infection or sexually transmitted infection, treating the underlying infection is essential for resolving all symptoms.

Main Causes of Orchitis

Understanding the causes of orchitis helps in prevention and early recognition of risk factors. The condition can develop from various sources, with infections being the most common culprits.

Viral Infections

Viral orchitis is most commonly associated with the mumps virus. Before widespread mumps vaccination, mumps-related orchitis was a frequent complication, affecting approximately 20-30% of post-pubertal males who contracted mumps. The orchitis typically develops 4-7 days after the appearance of mumps symptoms such as parotid gland swelling. Other viruses that can cause orchitis include Coxsackievirus, varicella virus (chickenpox), and certain enteroviruses.

Bacterial Infections

Bacterial orchitis often results from sexually transmitted infections (STIs), particularly gonorrhea and chlamydia, which are the leading causes in sexually active men under 35. These bacteria typically travel from the urethra through the reproductive tract to the epididymis and testicles. In older men or those with urinary tract abnormalities, bacterial orchitis may be caused by E. coli or similar organisms associated with urinary tract infections. The bacteria can reach the testicles through the bloodstream or by ascending from the urinary system.

Epididymitis Progression

Orchitis frequently develops as a complication of epididymitis, which is inflammation of the epididymis (the coiled tube at the back of the testicle that stores and carries sperm). When inflammation spreads from the epididymis to the testicle, the condition is called epididymo-orchitis. This progression occurs in approximately 20-40% of epididymitis cases and shares the same infectious causes.

Other Risk Factors

Several factors increase the risk of developing orchitis:

• Age: Young adult males are at higher risk for STI-related orchitis, while older men face increased risk from urinary tract-related infections
• Unprotected sexual activity: Having multiple sexual partners or not using barrier protection increases STI risk
• Urinary tract problems: Structural abnormalities, catheter use, or prostate enlargement can lead to infections
• Lack of immunization: Not being vaccinated against mumps increases viral orchitis risk
• Immunosuppression: Weakened immune systems make individuals more susceptible to infections
• Recent surgery: Urological procedures can occasionally introduce bacteria to the area

Prevention Strategies

While not all cases of orchitis can be prevented, several measures can significantly reduce your risk of developing this painful condition.

Vaccination

The MMR (measles, mumps, and rubella) vaccine is highly effective at preventing mumps and, consequently, mumps-related orchitis. Ensuring that you and your children receive this vaccination according to the recommended schedule is one of the most effective preventive measures. The vaccine is typically given in two doses during childhood, providing long-lasting immunity against mumps.

Practice Safe Sexual Behavior

Since sexually transmitted infections are a leading cause of orchitis in younger men, practicing safe sex is crucial for prevention:

• Use condoms consistently and correctly during sexual activity
• Limit the number of sexual partners
• Engage in regular STI screening, especially if you have multiple partners
• Ensure that both you and your partner(s) are tested and treated for STIs
• Maintain open communication with sexual partners about sexual health

Maintain Good Urinary Tract Health

Preventing urinary tract infections can help reduce the risk of orchitis developing from bacterial spread:

• Stay well-hydrated by drinking adequate water throughout the day
• Urinate when you feel the need; don’t hold urine for prolonged periods
• Practice good hygiene, especially before and after sexual activity
• Urinate after sexual intercourse to help flush bacteria from the urethra
• Address any urinary tract symptoms promptly with medical care

Seek Early Medical Attention

Prompt treatment of infections can prevent them from spreading to the testicles. If you experience symptoms of a urinary tract infection, STI, or any unusual genital symptoms, consult a healthcare provider immediately. Early intervention can prevent complications and reduce the likelihood of developing orchitis.

Frequently Asked Questions

How long does orchitis last?

The duration of orchitis varies depending on the cause and promptness of treatment. Bacterial orchitis typically begins to improve within 1-3 days of starting appropriate medical care, with complete resolution often occurring within 1-2 weeks. Viral orchitis usually resolves on its own within 3-10 days, though some cases may take several weeks. Without proper treatment, symptoms can persist for much longer and may lead to complications.

Can orchitis affect fertility?

Yes, orchitis can potentially impact fertility, particularly if both testicles are affected or if the condition is severe or left untreated. The inflammation can damage the sperm-producing tissues in the testicles, potentially leading to reduced sperm production or quality. However, most men who have had orchitis in one testicle maintain normal fertility. The risk of infertility is higher with bilateral mumps orchitis, affecting approximately 10-30% of cases involving both testicles.

Is orchitis contagious?

Orchitis itself is not contagious, but the infections that cause it can be transmitted. If orchitis is caused by a sexually transmitted infection like chlamydia or gonorrhea, the infection can be passed to sexual partners. Mumps, which can lead to viral orchitis, is highly contagious and spreads through respiratory droplets. If you have orchitis, it’s important to avoid sexual contact until treatment is complete and to take precautions to prevent spreading the underlying infection if it’s contagious.

When should I see a doctor for testicular pain?

You should seek medical attention immediately if you experience sudden or severe testicular pain, swelling, fever, or if pain is accompanied by nausea and vomiting. Even mild testicular pain that persists for more than a few days warrants medical evaluation. Prompt medical care is essential because several serious conditions, including testicular torsion (which requires emergency surgery), can present with similar symptoms to orchitis. Early diagnosis and treatment of orchitis can prevent complications and speed recovery.

Can orchitis come back after treatment?

Orchitis can recur, especially if the underlying cause isn’t fully addressed or if you’re re-exposed to infection. Men who have had one episode of bacterial orchitis may be at slightly increased risk for future episodes, particularly if risk factors like STI exposure or urinary tract problems persist. Following preventive measures, completing the full course of prescribed treatment, and addressing any underlying conditions can help reduce the risk of recurrence. If you experience recurring episodes, your healthcare provider may investigate underlying causes that need to be addressed.

Can I exercise with orchitis?

During the acute phase of orchitis, rest is generally recommended. Physical activity, especially strenuous exercise or activities that involve running, jumping, or heavy lifting, can increase pain and discomfort. Additionally, the movement and jarring can aggravate the inflamed testicle and potentially slow healing. It’s best to avoid exercise until symptoms significantly improve and your healthcare provider approves returning to physical activity. Supportive underwear can help minimize discomfort during the recovery period when you do resume normal activities.

References:

• Mayo Clinic – Orchitis
• NHS – Epididymitis and Orchitis
• Urology Care Foundation – Epididymitis and Orchitis
• Centers for Disease Control and Prevention – Mumps
• MedlinePlus – Orchitis