Can orchitis cause infertility?

Testicle pain, swelling, painful urination, pain, frequent urination are symptoms of orchitis that will bring a lot of discomfort and inconvenience to the patient. Moreover, there is concern about the effect on sperm production of the testicles, can inflammation of the testicle cause infertility? Let's learn about this disease that brings many fears and worries together.

content

• 1. Introduction
• 2. Basic structure and function of testicles 
• 3. Acute epididymitis
• 4. Acute Orchitis
• 5. Some knowledge about mumps virus

1. Introduction

Orchitis alone is in fact an uncommon disease. This pathology is often progressed by epididymitis, when epididymitis gets worse, it will spread to the testicles causing orchitis.

In the case of simple orchitis, the cause is mainly viral, specifically the mumps virus. Because there are many cases where orchitis is a complication of epididymitis. Collectively called epididymitis - testicles, so the article will also briefly review epididymitis for readers to understand more about these two diseases.

2. Basic structure and function of testicles 

Testicles have two types of structures: seminiferous tubules and interstitial cells. The seminiferous tubules produce sperm, and the interstitial cells secrete sex hormones. Sex hormones will help men with beards, muscles develop... show off the appearance of a man.

After the seminiferous tubules produce sperm, the sperm travels into the epididymis to reach the vas deferens. Based on the image above, it is clear that the epididymis is located posteriorly and superiorly to the testis, the epididymis is the most anterior structure if excluding the scrotal skin.

Structure of the testicles

3. Acute epididymitis

Along with testicular torsion, testicular appendage torsion, epididymitis is one of the common causes in patients with scrotal pain. Acute epididymitis can occur at any age. However, it is most often between the ages of 18 and 35, possibly because this is the age when male sexual activity is most active.

Reason:

• Infection
• Autoimmune disease
• Injury.

Most cases of orchitis are caused by an infection. Germs travel upstream from the urethra, to the vas deferens and to the epididymis. To identify the causes of bacterial epididymitis, we classify as follows:

For the group of male patients who regularly have sex (age 18-35), especially the group who have sex without a condom, epididymitis easily occurs. The main bacteria causing epididymitis at this time are Chlamydia trachomatis and gonorrhea (Nesseria gonorrhoeae).

Epididymitis-testis: A late progression of epididymitis

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• Skin rash, usually less than ½ of the body.
• Hematuria.
• Scrotal swelling (due to epididymitis).
• Abdominal pain intermittently.
• Swollen joint pain.

Scrotal pain due to aseptic epididymitis also belongs to the typical group of symptoms of Henoch Scholein

Medicines can also sometimes cause epididymitis. Amiodarone (an antiarrhythmic drug) has caused epididymitis in a few cases. In addition, in our country's environmental conditions, epididymitis may appear (tuberculosis epididymitis).

Risk factor:

• Sex without a condom.
• Difficulty urinating, urinary retention.
• Urogenital malformations.
• Strong, continuous sports activities.
• Drive a motorbike or bicycle regularly.

Symptom:

• Patients with epididymitis often go to the hospital because the scrotum is swollen and painful.
• This symptom usually begins in 1-2 days, with symptoms gradually worsening.
• In addition, patients with epididymitis often have burning, pain, difficulty urinating, and urinary frequency.
• Many people also have additional symptoms of discharge from the urinary tract.

On examination, the patient's testicles are swollen, tender, often red, and in most cases only on one side. In the early stages, inflammation is mainly in the epididymis, that is, the posterior part, above the testicle.

When the patient arrives later, the inflammation will spread to the entire testicle on the same side, causing epididymitis - orchitis. At this point, it is difficult to distinguish between patients with epididymitis leading to orchitis or orchitis at baseline.

Your doctor will be concerned about a number of things:

• Does your scrotal swelling come on intensely, quickly?
• In addition to swelling and pain in the scrotum, do you have burning, burning, and stinging when urinating?
• Recently, in the morning, have you noticed that your urinary hole has a discharge, pus or not?
• Have you recently had mumps?
• If not, are your sex times safe?
• What were the difficulties in urinating before testicle swelling?
• Do you have to ride a motorbike (bicycle) continuously for a long time?
• What medication are you taking?
• Have you had any medical procedures in the past 3 to 4 weeks? (Usually a catheterization – the tube that carries urine from the bladder to the urethral opening in the penis).
• Have you ever been diagnosed with tuberculosis?

All of these questions serve several purposes:

• Do you have testicular torsion? This is the most important issue when the patient comes to the initial examination, because testicular torsion is a disease requiring emergency surgery. Early recognition of testicular torsion can help patients preserve the testicle, because if late, orchiectomy is mandatory.
• Is this epididymitis or orchitis?
• If epididymitis, what causes epididymitis?
• If epididymitis is caused by bacteria, what is the most likely or suspected culprit?

Test:

• Urinary tract pus staining:

The medical staff will numb, reduce sensation in the penis area, then take a stick to collect pus in the urethra to find the culprit. In about two-thirds of cases it will be intestinal bacteria if the patient is not at risk of having sex without a condom.

• Urine culture:

If there is no pus in your urinary tract, your healthcare provider will use your urine to look for bacteria that cause illness.

• Supersonic:

Usually not necessary, but plays a role in diagnosing complications or ruling out testicular torsion.

Symptoms:

• Rarely, include:
• Testicular infarction (due to inflammation of the blood vessels supplying the testicles).
• Testicular abscess.
• Chronic epididymitis.
• Infertility.

Treatment:

Most acute epididymitis is caused by bacteria, so depending on the cause, your doctor will have your own treatment options.

Specific treatment: Antibiotics: Help kill bacteria that cause epididymitis.

• For subjects with acute epididymitis not related to sex. Antibiotics against enteric bacilli and coccidiosis are prioritized for treatment before culture results are available.
• For subjects with acute epididymitis suspected of having sex without a condom, the doctor will have specific drugs for these agents. In addition, in this case, it is extremely important to diagnose and treat the disease in the patient's sexual partner, because the adnexitis caused by these agents may affect the patient's fertility later in life. .

Supportive treatment:

Chill out, use pain relievers, wear underwear that hugs the scrotum, and rest in bed. The goal of these treatments is to relieve pain and reduce swelling of the epididymis.

4. Acute Orchitis

Inflammation of the epididymis and testicles

As mentioned, isolated acute orchitis is uncommon. Acute orchitis differs from acute epididymitis in 2 points:

• The main route of infection is hematogenous (from blood vessels in the spermatic cord). At this time, the inflammatory agents will travel from another location on the body, into the bloodstream and then to the testicles.
• The most common causative agent of acute orchitis is a virus. And mumps is the virus most often mentioned, as well as the causative agent of orchitis in most cases. We often call this case mumps orchitis, or possibly viral orchitis.

Symptom:

Swollen testicles usually appear 4-6 days after parotid gland swelling. However, orchitis may present without prior parotid gland inflammation. When orchitis is caused by mumps alone, 70% of cases are unilateral. Rectal orchitis occurs 1 to 9 days later in 30% of cases.

Inflammation of the parotid gland

The degree of swelling and pain in the scrotum is very variable, there may be only mild discomfort, little swelling, but also a lot of pain, swelling, accompanied by nausea and vomiting, high fever. On physical examination, the testicles are swollen, hot and red, and the epididymis and vas deferens can also be palpated. Symptoms will subside in 4-5 days if mild. Up to 3-4 weeks in severe cases.

In older studies, 25% of bilateral mumps orchitis cases resulted in infertility. However, recent studies refute that. In very few cases, mumps orchitis causes infertility. In addition to Mumps, infection with the Coxsackie B virus can also cause orchitis.

In case of bacterial orchitis:

Also known as pyelonephritis. Most are associated with epididymitis, and intestinal bacteria are the predominant cause. Patients often present with very severe disease:

• Sluggish, tired.
• High fever.
• Very painful, uncomfortable and swollen area of ​​the affected scrotum.

Pain may radiate to the groin area. At this time, the patient is in a lot of pain, possibly accompanied by nausea and vomiting. On examination, the scrotum is swollen, a lot of fluid is secreted by inflammatory fluid from the testicle. This fluid is located under the skin of the scrotum and the seminal vesicles. It is difficult to palpate the testicle, and it is a bit painful to press (because there is a lot of fluid, so it is difficult to palpate).

Symptoms:

• More common than acute epididymitis
• Testicular infarction.
• Testicular abscess.
• Treatment of these complications is mainly surgical.

5. Some knowledge about mumps virus

Mumps is a virus that is spread through the respiratory tract when an infected person coughs or sneezes. Or spread through shared utensils without washing hands with soap. Treatment of mumps is mainly to relieve symptoms for the patient.

The vaccine against mumps is integrated into the MMR (measles-mumps-rubella) vaccine. Vaccination is required twice in life, at 12-15 months of age and 4-6 years of age. If you haven't had enough or don't remember if you've had enough, you should get a booster shot.

Who should not get the mumps vaccine:

• Allergic to MMR vaccine at 1 year of age.
• Allergy to gelatin or neomycin.
• Women who are pregnant or planning to become pregnant in the next 1 month.
• Immunocompromised patients (due to chemotherapy, HIV/AIDS infection or prolonged corticosteroid use).

Epididymitis, epididymitis - orchitis, or orchitis are all conditions that cause a lot of discomfort to patients. Understanding more about these diseases helps us to draw some of the following knowledge to prevent and recognize epididymitis and testicular inflammation:

• Practice safe sex, use condoms, and be monogamous.
• Do not sit on a motorbike or bicycle for too long and continuously.
• Complete 2 doses of mumps vaccine (12-15 months of age and 4-6 years of age), if not, get additional vaccination immediately.
• When there is swelling and pain in the scrotum, you need to go to the doctor immediately for examination and treatment.
• Excluding testicular torsion is the most necessary thing when the patient has swelling and pain in the scrotum.
• Mumps orchitis rarely leads to infertility. Bacterial orchitis can cause infertility if treatment is delayed.
• Complications from epididymitis and orchitis are rare, but if not treated promptly, surgery to remove the testicle is difficult to avoid.

Doctor Nguyen Doan Trong Nhan