Epididymo-orchitis (Infection of the Testicle)

Epididymo-orchitis (infection of the testicle)

Epididymitis is inflammation of the epididymis (the structure next to the testicle (testis) that is involved in storing sperm).

Orchitis is inflammation of the testicle.

Epididymo-orchitis is an inflammation of the epididymis and/or testicle (testis), usually occurring as a combination. It is usually due to infection, either from a urine infection or a sexually transmitted infection.

Usually both epididymitis and orchitis occurs together due to the close proximity of both structures and subsequent infection occurring simultaneously in both structures. But at times they may only involve the single structure, e.g. mumps orchitis.

Epididymo-orchitis presents as a swelling of the scrotum and testicle, usually associated with pain.

HOWEVER, testicular pain and swelling is not always due to epididymo-orchitis.

Testicular torsion (twisting of the testicle) also may present in the same manner, and is considered an emergency (see earlier section on testicular torsion).

Pic from Patient info; https://patient.info/mens-health/scrotal-lumps-pain-and-swelling/epididymo-orchitis


Urinary tract infection in the male (UTI)

Sexually transmitted disease / infection (STD / STI)

Mumps orchitis

Urethral strictures (narrowing of the urinary passage), BPH (“prostate enlargement”), prostatitis (infection of the prostate)

After operations on the prostate (Transurethral resection of prostate / TURP) or instrumentation

After long-term urethral catheter, associated prostate infection

Various other uncommon infections


Enlarged testicle and / or epididymis, painful

In severe cases characterized by redness of scrotal skin with pain

In delayed or untreated cases, sepsis and septicemia (spread of the infection outside the testicle into the blood stream)


The doctor will subject you to a few investigations after a detailed history and examination including often a rectal examination of the prostate.

Investigations include ultrasound of the testicles, ultrasound of the pelvis, kidney and bladder, possibly uroflowmetry, and often blood tests if there are severe symptoms.

The treatment proper of edididymo-orchitis is the treatment of the infectious agent (usually bacteria), followed by the cause of the epididymo-orchitis which includes addressing the treatment of urethral strictures (narrowing of the urinary passage), BPH (“prostate enlargement”), prostatitis (infection of the prostate), etc.

There are times when the infection continues to progress into an abscess (pus collection). If this occurs, the doctor may subject you to a procedure to drain out the pus with a small incision.

Very rarely, the infection may be very bad and can cause necrosis (testicular death), for which then the testicle must be removed.

If left untreated, this condition can progress to abscess formation, necrosis (death of the testicle) or can even be a predisposing factor for Fournier’s gangrene (a severe condition where a flesh-eating bacteria which can cause the tissues to be eaten and requires large removal of tissues in the scrotum).

When to see your doctor

When there is pain and enlargement of the testicle

Remember, in males this condition may be related to STD / STI

Epididymo-orchitis is very uncommon to rare in children.

Beware – in children, adolescents and young adults, testicular torsion may present in the same manner. Testicular torsion is an emergency where the patient will have to go to the Emergency Department with 4-6 hours of the swelling and pain if the testicle is to be saved.

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