Dr. med. Dirk Manski

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Causes, Diagnosis and Treatment of Orchitis

Definition of Orchitis

Acute orchitis is an inflammation of the testicular parenchyma of various causes with swelling and pain. Chronic orchitis is an inflammation of the testicular parenchyma that lasts longer than six weeks.


The true incidence of orchitis is unclear, but it is much less common than epididymitis. Common is the inflammation of the testis due to acute epididymitis (epididymoorchitis). Isolated orchitis (without epididymitis) is rare and usually caused by viruses.

Etiology and Differential Diagnosis of Orchitis

Signs and symptoms of Orchitis

Typical are redness, pain, and swelling of the affected scrotal compartment and testis, in addition to the symptoms of the underlying disease.

Diagnosis or Orchitis

ultrasound imaging of an epididymitis
Testicular ultrasound imaging of advanced epididymoorchitis: Inhomogeneous echo pattern of testicular parenchyma and epididymis (NH) as signs of epididymoorchitis. With kind permission, J. Menzinger, München.

Treatment of Orchitis

General measures are bed rest, scrotal elevation and cooling, and anti-inflammatory drugs such as diclofenac. Further specific therapy depends on the suspected disease; a calculated antibiotic therapy with fluoroquinolones or cephalosporins is often begun until further laboratory results are available.

Diagnosis and Treatment of Mumps Orchitis

Definition of Mumps Orchitis

Mumps orchitis is an acute viral orchitis and a complication of epidemic parotitis.


Mumps orchitis develops in 30% of patients with mumps after puberty, and 10–30% have bilateral manifestations.

Etiology and Pathogenesis of Mumps Orchitis

The mumps virus is a neurotropic paramyxovirus with single-stranded RNA. Orchitis leads to infiltration of lymphocytes, damage to the blood-testis barrier, and edema with the rise of intratesticular pressure with pressure atrophy (caused by the inelastic tunica albuginea). Infertility, subfertility, and hypogonadism may develop depending on the extent of the (bilateral) disease.

Signs and Symptoms of Mumps Orchitis


See the section "Diagnosis of orchitis" above.

Treatment of Mumps Orchitis

General measures include bed rest, scrotal elevation, cooling, NSAR or glucocorticoids. In doubtful situations, calculated antibiotic therapy with fluoroquinolones or cephalosporins is begun until further laboratory results are available. Interferon-α (Ku et al., 1999) was successfully used to treat mumps orchitis and to prevent testicular atrophy. However, this is not the standard of care.

Treatment of Infertility after Mumps Orchitis

In the case of azoospermia, recommend testicular sperm extraction (TESE) and ICSI.

Prognosis of Mumps Orchitis

Bilateral orchitis may cause testicular atrophy with infertility, in severe cases with hypergonadotropic hypogonadism.

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Ku, J. H.; Kim, Y. H.; Jeon, Y. S. & Lee, N. K. The preventive effect of systemic treatment with interferon-alpha2B for infertility from mumps orchitis.
BJU Int, 1999, 84, 839-842.

Manson 1990 MANSON, A. L.: Mumps orchitis.
In: Urology
36 (1990), Nr. 4, S. 355–8

M. Masarani, H. Wazait, and M. Dinneen, “Mumps orchitis.,” J R Soc Med, vol. 99, no. 11, pp. 573–575, 2006, doi: 10.1258/jrsm.99.11.573.

  Deutsche Version: Mumps Orchitis