​Orchiepididymitis, Orchitis and Epididymitis Infection of the epididymis and testis

Orchiepididymitis is an inflammatory process of the epididymis and adjacent testis which can affect men of all age groups, but is more frequent between 14 and 35 years old.

It is usually caused by a bacterial infection or a sexually transmitted disease. The infectious process is caused by the migration of pathogenic microorganisms from the urethra or bladder, with emphasis on bacteria such as Enterobacteriaceae (typically E. coli), C. trachomatis and N. gonorrhoeae. The latter two are the most common agents in men aged 35 and under.

Orchiepididymitis may be manifested only by mild symptoms, however, if left untreated, complaints tend to worsen.

Orchiepididymitis can present in an acute, chronic or recurrent form:

- Acute infection can last up to about 6 weeks, and it is sometimes difficult to differentiate between the infectious process that predominantly affects the epididymis or testis.

- Chronic orchiepididymitis, in turn, has a duration of more than 6 weeks, characterized essentially by a sensation of discomfort or pain located at the scrotum. This can be caused by granulomatous inflammatory processes, sometimes degenerating into cystic lesions or calcifications.

The most frequent symptoms are: pain or discomfort in the testicle; flushing and heat at the scrotal level; fever; chills; increased volume of ganglia in the inguinal region; pain during urination; increased frequency of urination and a feeling of urge to urinate; urethral discharge; appearance of blood in the sperm (hematospermia).

The diagnosis is based on an objective examination in which the local inflammatory signs are assessed at the level of the epididymis, testis and scrotum, as well as the inguinal and perineal region, and the existence of urethral discharge is also assessed.

In this type of pathology, it is particularly important to perform cultural tests of urine and urethral exudate, in order to identify the microorganism that is causing the infectious process and adjust the therapeutic strategy.

Blood tests may also be important to assess the severity of the infectious process at a systemic level.

Carrying out an imaging evaluation using scrotal ultrasound is essential to evaluate the testicles and epididymis, as well as the surrounding tissues.

The differential diagnosis between this pathology and torsion of the spermatic cord is extremely relevant, especially in the case of adolescents and young adults.

The treatment of orchiepididymitis should aim at the elimination of the infectious process and mitigation of associated symptoms.

In the case of a bacterial orchiepididymitis, the use of antibiotics is crucial, with the duration of treatment being longer when compared to the treatment of simple urinary infections. In order to ensure the complete eradication of the infection, the recommended antibiotic regimen should be followed until the end, regardless of early or significant clinical improvements. The symptomatic improvement is usually evident within 48 to 72 hours after starting treatment.

Analgesic and anti-inflammatory medication is also used for symptom relief. Additional measures such as bed rest, scrotal suspension and local application of ice are also very effective.

In the case of a sexually transmitted infection, avoidance of sexual contact and partner evaluation is of paramount importance.

In situations in which the infectious process progresses to abscess, it may be necessary to resort to surgical intervention to drain it. Sometimes, there is also a need for complete or partial removal of the epididymis.

The need for surgical therapy should also be considered when Orchiepididymitis is caused by pre-existing structural abnormalities that may lead to infectious complications of the genitourinary system.