Understanding the Infertility Risks Associated with Three Types of Orchitis

The testis is the primary male reproductive organ, which produces sperm. Sperm and eggs combine to form a new individual, thus continuing the human race. In addition, it secretes male hormones, which can affect the development of sperm and male accessory organs and secondary sexual characteristics. Therefore, congenital developmental disorders or testicular lesions caused by many acquired factors can lead to infertility.

Orchitis is an inflammatory lesion of the testis caused by various pathogenic factors, which can be divided into non-specific, bacterial, fungal, spirochete, parasitic, traumatic, chemical, and other types. Specific orchitis is mainly caused by epididymal tuberculosis invading the testis, which is rare. The common ones in clinical practice are non-specific orchitis and mumps orchitis, which are the common causes of male infertility.

I. Acute non-specific orchitis

Acute non-specific orchitis often occurs in patients with urethritis, cystitis, prostatitis, prostatectomy, and long-term indwelling catheterization. The infection spreads to the epididymis through lymphatic or vas deferens, causing epididymal orchitis. The common pathogens are Escherichia coli, Proteus, Staphylococcus and Pseudomonas aeruginosa, etc. Bacteria can spread to the testicles through the bloodstream, causing simple orchitis. However, the testicles have a strong resistance to infection due to their rich blood supply, so this condition is rare.

Pathologically, the testicles are mainly enlarged, congested, and tense upon gross observation. When the testicles are cut open, small abscesses can be seen. Histologically, there is focal necrosis, connective tissue edema, and infiltration of segmented nuclear cells. The seminiferous tubules have inflammation, bleeding, and necrosis. In severe cases, testicular abscess and testicular infarction can occur.

The diagnosis mainly relies on clinical symptoms such as high fever, chills, testicular pain and swelling, redness, and swelling of the scrotum, etc. It must be distinguished from acute epididymitis, mumps orchitis, testicular torsion, and incarcerated hernia.

Early diagnosis and timely administration of antibiotics to eliminate the cause are essential measures to protect good function in the future. In a few cases of orchitis, fibrosis and damage to the seminiferous tubules can lead to testicular atrophy and affect fertility.

II. Chronic non-specific orchitis

Chronic orchitis is often caused by poor treatment of non-specific acute orchitis. It can also be caused by infections such as fungi, spirochetes, and parasites, such as granulomatous orchitis in patients with a history of testicular trauma. Local or systemic radioisotope phosphorus irradiation of the testis can also cause testicular inflammation and tissue damage.

Pathologically, the testis is enlarged or atrophied and hardened, the basement membrane of the seminiferous tubules shows hyaline degeneration and atrophy, and the germinal epithelial cells disappear. Sclerosis may occur around the seminiferous tubules, and small proliferative foci may also form.

Clinical examination shows chronic testicular enlargement, hard texture with a smooth surface, slight tenderness on palpation, and loss of normal sensitivity. Some testes gradually shrink, and in severe cases, the testes are almost undetectable, showing relative enlargement of the epididymis. In most cases, the inflammation spreads from the epididymis to the testis, and the boundary between the two is unclear. Bilateral chronic orchitis can often cause infertility.

Treatment mainly targets the cause of chronic orchitis. Natural medicine Diuretic and Anti-inflammatory Pill can effectively treat chronic orchitis caused by different reasons.

III. Acute parotitic orchitis

Epidemic mumps is a common cause of orchitis, with approximately 20% of mumps patients developing orchitis. It is more common in late adolescence. The testicle is visibly swollen and appears purple or blue. When the testicle is incised, the tubules cannot be squeezed out due to interstitial reaction and edema. 

Histological observation shows edema and vascular dilation, a large number of infiltrating inflammatory cells, and varying degrees of degeneration of the seminiferous tubules. During the healing of orchitis, the testicle becomes smaller and softer. The seminiferous tubules are severely atrophied, but the interstitial cells of the testicle are preserved, so testosterone secretion is not affected.

Orchitis generally occurs 3-4 days after parotitis, with redness and swelling of the scrotum, unilateral or bilateral testicular enlargement and high tenderness, and occasionally hydrocele. The parotitis lesion can generally be found, and after symptomatic treatment for about 10 days, the testicular swelling subsides. About 1/3 to 1/2 of patients can observe testicular atrophy 1-2 months after onset. Generally, unilateral testicular involvement does not affect fertility.

According to statistics, about 30% of patients with orchitis caused by epidemic parotitis experience irreversible damage to their sperm, and the affected testicles are highly atrophied. In the case of bilateral infection, the testicles may atrophy, causing infertility due to impaired sperm production, but testosterone function is generally normal.

Recommended Readings:

Orchitis Patients Still Has Symptoms After 6 Months, What Should You Do?

With Orchitis, Can People Give Birth with Only One Testicle?

From Inflammation to Infertility: Exploring the Link Between Orchitis and Azoospermia