Testicular infection or torsion

Definition

Testicular infection or torsion is a group of disorders in which testicular pain is a primary symptom.

Causes, incidence, and risk factors

Disorders associated with testicular infection or pain include epididymitis, orchitis, testicular trauma, and testicular torsion.

Epididymitis is an inflammation of the epididymis (the structure that is the first part of the duct draining each testis). Orchitis is an inflammation of one or both of the testicles. These disorders may be caused by numerous bacterial and viral organisms. Epididymitis is the most common cause of scrotal or testicular pain in individuals over 18 years of age.

Testicular torsion is a twisting of the spermatic cord, artery and vein, which cuts off the blood supply to the testicle and surrounding structures within the scrotum. If not corrected promptly, the tissues of the testicle will die.

Diagnosis and surgery should take place within 6 hours. If surgery is delayed more than 6 hours, the testicle will often need to be removed. Testicular torsion is the most common cause of scrotal or testicular pain in boys and non-sexually active adolescents. The majority of cases of testicular torsion are in boys less than 6 years of age.

Symptoms

     
  • Sudden onset of testicle pain (in one or both testicles) with or without a predisposing event  
  • Scrotal swelling  
  • Extreme tenderness to pressure or traction on the testis

Specific to orchitis and epididymitis:

     
  • Fever  
  • Chills or chilling sensation  
  • Discharge (fluid) from penis

Additional symptoms that may occur:

     
  • Testicle lump  
  • Blood in the semen  
  • nausea/vomiting  
  • Light headedness or fainting  
  • Blood in the semen  
  • Pain with urination  
  • Pain with intercourse or painful ejaculation  
  • Groin pain

Signs and tests

Physical examination is often sufficient to diagnose testicular torsion, orchitis, and epididymitis. Radiographic tests may be required to differentiate testicular torsion from infectious causes of testicular pain. Often, tests will be needed to determine the causative organism for infections.

Treatment

If the cause is bacterial, epididymitis and orchitis may respond to antibiotics. Pain medications (analgesics) and other treatments may be recommended.

Prompt surgery is required for testicular torsion.

Expectations (prognosis)
With appropriate diagnosis and adequate treatment, normal function of the testicle is usually preserved. If the infection is severe or testicular torsion is not surgically corrected promptly, infertility and testicular atrophy (shrinkage) may result.

Complications

     
  • Loss of testicular function (infertility)  
  • Severe infection

Calling your health care provider
Any time there is persistent or severe testicular pain, with or without any of the other symptoms listed above, call your health care provider promptly.

Prevention

Epididymitis and orchitis are frequently, but not always, associated with sexually-transmitted diseases.

There are no special preventive measures for testicular torsion. A high index of suspicion and early diagnosis and surgery will prevent loss of a testicle.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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