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Orchitis is an inflammation of one or both testicles, most commonly associated with the virus that causes mumps. At least one-third of males who contract mumps after puberty develop orchitis.

Other causes of orchitis usually are bacterial, including sexually transmitted diseases (STDs), such as gonorrhea or chlamydia. Bacterial orchitis often results from epididymitis, an inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm. In that case, it's called epididymo-orchitis.

Swelling and pain are the most common signs and symptoms of orchitis.

Orchitis symptoms usually develop suddenly. Orchitis symptoms may include:

• Testicular swelling on one or both sides
• Pain ranging from mild to severe
• Tenderness in one or both testicles, which may last for weeks
• Nausea
• Fever
• Discharge from penis
• Blood in the ejaculate

The terms "testicle pain" and "groin pain" are sometimes used interchangeably. But groin pain occurs in the fold of skin between the thigh and abdomen — not in the testicle. The causes of groin pain are different from the causes of testicle pain.

When to see a doctor
If you experience pain or swelling in your scrotum, especially if the pain comes on suddenly, see your doctor right away.

A number of conditions can cause testicular pain, and some of the conditions require immediate treatment. One such condition involves twisting of the spermatic cord (testicular torsion), which may cause pain similar to that caused by orchitis. Your doctor can perform tests to determine which condition is causing your pain.

Orchitis can be either bacterial or viral.

Bacterial orchitis
Most often, bacterial orchitis is the result of epididymitis, an inflammation of the coiled tube that connects the vas deferens and the testicle. The vas deferens carries sperm from your testicles. When inflammation in the epididymis spreads to the testicle, the resulting condition is known as epididymo-orchitis.

Epididymitis usually is caused by an infection of the urethra or bladder that spreads to the epididymis. Often the cause of the infection is a sexually transmitted disease (STD), particularly gonorrhea or chlamydia. Other causes of infection may be related to having been born with abnormalities in your urinary tract or having had a catheter or medical instruments inserted into your penis.

Viral orchitis
Most cases of viral orchitis are the result of mumps. About one-third of males who contract the mumps after puberty develop orchitis during their course of the mumps, usually four to six days after onset.

Several factors may contribute to developing orchitis. For nonsexually transmitted orchitis, they include:

• Not being immunized against mumps
• Being older than 45
• Having recurring urinary tract infections
• Having surgery that involves the genitals or urinary tract, because of the risk of infection
• Being born with an abnormality in the urinary tract (congenital)

High-risk sexual behaviors that can lead to STDs also put you at risk of sexually transmitted orchitis. They include having:

• Multiple sexual partners
• Sex with a partner who has an STD
• Sex without a condom
• A personal history of an STD

Complications of orchitis may include:

• Testicular atrophy. Orchitis may eventually cause the affected testicle to shrink.
• Scrotal abscess. The infected tissue fills with pus.
• Repeated epididymitis. Orchitis can lead to recurrent episodes of epididymitis.
• Infertility. In a small number of cases, orchitis can reduce fertility; however, if orchitis affects only one testicle, sterility is less likely.

You're likely to start by seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment you may be referred immediately to a doctor who specializes in urinary issues (urologist).

To get all the information you need from your doctor, it helps to be well prepared for your appointment. Here's how.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Make a list of your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Give your doctor a history of your childhood illnesses and immunizations.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Preparing questions ahead of time will help you make the most of your time with your doctor. List your questions from most important to least important. For orchitis, some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• Other than the most likely cause, what are other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• Is my condition likely to become chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• I have other health conditions. How can I best manage them with my orchitis?
• Are there any restrictions that I need to follow?
• Should I see a specialist?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

Don't hesitate to ask other questions that arise during your appointment any time you don't understand something or need clarification.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Have you had mumps or mumps vaccine? If so, when?
• Have you had an STD?
• Do you practice safe sex, such as using a condom or having only one partner?

Your doctor will do a physical exam, which may reveal enlarged lymph nodes in your groin and an enlarged testicle on the affected side; both may be tender to the touch. Your doctor may do a rectal examination to check for prostate enlargement or tenderness and order blood and urine tests to check for infection and other abnormalities.

Other tests your doctor might order to determine the presence of an STD and to rule out the possibility of testicular torsion, which requires immediate treatment, include:

• STD screening. This involves obtaining a sample of discharge from your urethra. Your doctor may insert a narrow swab into the end of your penis to obtain the sample, which will be viewed under a microscope or cultured to check for gonorrhea and chlamydia.
• Urinalysis. A sample of your urine, collected either at home first thing in the morning or at your doctor's office, is analyzed in a lab for abnormalities in appearance, concentration or content.
• Ultrasound imaging. This test, which uses high-frequency sound waves to create precise images of structures inside your body, may be used to rule out twisting of the spermatic cord (testicular torsion). Ultrasound with color Doppler can determine if the blood flow to your testicle is reduced or increased, which helps confirm the diagnosis of orchitis.
• Nuclear scan of the testicles. Also used to rule out testicular torsion, this test involves injecting tiny amounts of radioactive material into your bloodstream. Special cameras can then detect areas in your testicles that receive less blood flow, indicating torsion, or more blood flow, confirming the diagnosis of orchitis.

Treatment depends on the cause of orchitis.

Treating viral orchitis
Treatment for viral orchitis, the type associated with mumps, is aimed at relieving symptoms. Your doctor may prescribe pain medication, nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others), and recommend bed rest, elevating your scrotum and applying cold packs.

Treating bacterial orchitis
In addition to steps to relieve discomfort, bacterial orchitis and epididymo-orchitis require antibiotic treatment. If the cause of the infection is an STD, your sexual partner also needs treatment.

Antibiotic drugs most commonly used to treat bacterial orchitis include ceftriaxone (Rocephin), ciprofloxacin (Cipro), doxycycline (Vibramycin, Doryx), azithromycin (Zithromax), and trimethoprim and sulfamethoxazole combined (Bactrim, Septra). Make sure your doctor is aware of any other medications you're taking or any allergies you have. This information, as well as whether your infection is sexually transmitted and what type of STD you have, will help your doctor select the best treatment.

Be sure to take the entire course of antibiotics recommended by your doctor. Even if your symptoms clear up sooner, take all your antibiotics to ensure that the infection is gone.

To ease your discomfort, try these suggestions:

• Rest in bed.
• Lie down so that your scrotum is elevated.
• Apply cold packs to your scrotum as tolerated.

Practicing safer sex, such as having just one sex partner and using a condom, helps protect against STDs, which helps prevent STD-related bacterial orchitis.

Getting immunized against mumps is your best protection against viral, mumps-related orchitis.