Epididymo-Orchitis and Orchitis

Definition:
Epididymo-orchitis occurs when the testicle (or testis) and epididymis (the coiled tube that lies above and behind the testicle and stores and carries sperm) become infected. Bacteria are usually to blame although the infection may be due to a virus or rarely a parasite such as schistosomiasis, or a fungus.
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When infection develops, these two structures become inflamed and swollen, the scrotum feels tender and is red on the side affected. The symptoms usually start after a few hours, and when severe can cause fever and great pain.

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Symptoms:
Epididymo-orchitis symptoms may develop suddenly  it  includes:

*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.

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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.

Causes:
The bacteria that cause epididymo-orchitis may get to the testis and epididymis in different ways. In younger men, the bacteria have usually travelled from the penis, having been passed on during sex.

In older men, prostatitis (infection of the prostate gland) or urinary infection is usually to blame. Epididymo-orchitis can also follow any medical procedure involving the urinary tract, such as catheterisation of the bladder or a cystoscopy.

Rarely, the infection arrives from the bloodstream, such as when the micro-organism responsible is tuberculosis (TB) which travels from a source of infection elsewhere in the body. Years ago, before the introduction of immunisation, infection with the mumps virus was a common cause of epididymo-orchitis.

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.

Risk Factors:
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:

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#Multiple sexual partners

#Sex with a partner who has an STD

#Sex without a condom

#A personal history of an STD

Complications:
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.

Diagnosis:
A physical examination 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 many times  required 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 :
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.

Prognosis:
Prognosis is very good.If the diseases is properly diagnosed in time it is cured with proper  drug and rest.

Life Style & Home Remedies:
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.

Prevention:
*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.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/epididymalcyst.shtml
http://www.mayoclinic.com/health/orchitis/DS00602
http://www.patient.co.uk/health/Epididymo-orchitis.htm
http://health.allrefer.com/health/orchitis-male-reproductive-system.html
http://www.sciencephoto.com/images/download_lo_res.html?id=778650061

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