What are epididymitis and orchitis?
Epididymitis is inflammation of the system of small tubes behind the testicle that collects sperm cells (the epididymis). Orchitis is inflammation of the testicle itself. The two often occur together.
Causes
- In children: most often a germ-free inflammation that develops after a viral infection or as a result of irritation. Sometimes urine flows back into the ducts of the testicle because of a urinary tract anomaly.
- Bacterial infection: together with a urinary tract infection.
- Viral orchitis: after mumps, usually in adolescents.
- In sexually active adolescents: sexually transmitted infections.
Symptoms
- pain and swelling in the testicle that start gradually,
- redness and warmth of the scrotum,
- sometimes fever, burning when urinating.
These symptoms are very similar to testicular torsion. Until torsion has been ruled out, any sudden testicular pain needs urgent examination.
Diagnosis
- physical examination,
- Doppler ultrasound: with inflammation, blood flow to the testicle increases; with torsion, it decreases,
- urinalysis and urine culture.
Treatment
- rest, keeping the scrotum slightly raised,
- pain relievers and anti-inflammatory medicines,
- antibiotics only if there are signs of infection in the urine or a bacterial cause is suspected.
Symptoms usually ease within a few days; the swelling may take 2–4 weeks to go away completely.
Recurrent epididymitis
If the inflammation comes back, a structural problem of the urinary tract should be looked for (ectopic ureter, anomalies of the urethra, bladder dysfunction). For this, an ultrasound is done and, when needed, a VCUG (voiding cystourethrogram) or cystoscopy.
When to seek urgent care
If any of the following is present, do not wait for a routine appointment: call the doctor or go to the nearest emergency department.
- Sudden, severe pain in the testicle (torsion must be ruled out)
- High fever, chills
- Rapidly increasing redness and swelling of the scrotum
Note for pediatricians and family doctors
In prepubertal boys epididymitis is usually sterile, post-infectious or reactive; urinalysis is normal and antibiotics are not required. If there is pyuria or a positive urine culture, antibiotics should be started and an ultrasound should be done to look for an anatomical anomaly of the urinary tract (ectopic ureter, urethral problems). Recurrent epididymitis requires further workup. In a sexually active adolescent, sexually transmitted infections should be considered.
What happens at the visit?
- The scrotum is examined and the condition is distinguished from testicular torsion and torsion of the appendix testis.
- A Doppler ultrasound and urinalysis are done.
- Treatment is prescribed according to the cause; in recurrent cases the urinary tract is evaluated.
Frequently asked questions
Can mumps spread to the testicle?
Yes, the mumps virus can cause inflammation of the testicle (orchitis) in adolescents. Vaccination prevents this.
Related topics
Sources
- EAU Guidelines on Paediatric Urology, 2025: Acute scrotum.
This page is for education. Decisions about your child’s treatment are made together with the doctor after an examination.