Can an asymptomatic Sexually Transmitted Disease (STD) cause testicular atrophy?

Can Asymptomatic STDs Cause Testicular Atrophy?

Yes, asymptomatic sexually transmitted infections, particularly chlamydia and gonorrhea, can cause testicular atrophy through untreated epididymitis and chronic orchitis, even when the initial infection produces no symptoms.

The Asymptomatic STD Problem

The critical issue is that most STDs in men are asymptomatic, creating a pathway to complications without warning signs:

• 68-92% of men with gonorrhea report no symptoms 1
• 92% of men with chlamydia are asymptomatic 1
• These infections can progress to epididymitis, which itself may be asymptomatic or minimally symptomatic 1

Mechanism of Testicular Damage

Acute to Chronic Progression

• Untreated chlamydia and gonorrhea cause epididymitis in men under 35 years, which is the primary sexually transmitted complication 1, 2
• Epididymitis can progress to epididymo-orchitis, extending inflammation from the epididymis to the testicular tissue itself 3
• Chronic orchitis leads to irreversible damage to spermatogenesis and testicular atrophy through prolonged inflammatory processes 3

Subclinical Inflammation

• Systematic histopathological analyses show high prevalence of asymptomatic inflammatory reactions in testicular biopsies from infertile men 3
• Focal lymphocytic infiltrates correlate with the degree of damage to spermatogenesis and testicular function 3
• Chronic asymptomatic inflammations are underestimated as causes of testicular dysfunction because noninvasive diagnostic techniques are not yet available 3

Clinical Implications

Why This Matters

• Most curable STDs go unrecognized and untreated without screening efforts to detect asymptomatic infections 1
• Providing treatment only for symptomatic patients misses the majority of infections that can still cause complications 1
• The window for preventing irreversible testicular damage closes once chronic inflammation is established 3

Prevention Strategy

• Screen all sexually active men under 35 at risk for STDs, regardless of symptoms, to prevent progression to epididymitis and orchitis 1
• Treat empirically with regimens effective against both chlamydia and gonorrhea when epididymitis is suspected (ceftriaxone 250 mg IM plus doxycycline 100 mg twice daily for 10 days) 1
• Retest all patients 3 months after treatment due to high likelihood of reinfection 1

Common Pitfalls

• Assuming absence of symptoms means absence of disease: The majority of STD infections in men produce no symptoms but can still cause testicular damage 1
• Waiting for symptoms before screening high-risk patients: By the time testicular atrophy develops, the damage is often irreversible 3
• Failing to treat sex partners: Untreated partners lead to reinfection and continued risk of complications 1
• Not recognizing chronic orchitis as an STD sequela: Asymptomatic inflammatory reactions in the testicles are frequently overlooked as primary causes of testicular atrophy in infertile men 3