What is nonspecific orchitis (inflammation of the testis)?

From the Guidelines

Nonspecific testicular inflammation, also known as nonspecific orchitis, is an inflammatory condition of the testicle that occurs without a clearly identifiable cause, and its diagnosis and management should prioritize reducing inflammation and pain to prevent complications such as testicular atrophy or fertility issues.

Key Characteristics

• Unlike specific forms of orchitis that are linked to known pathogens like mumps virus or bacterial infections, nonspecific testicular inflammation lacks a definitive infectious agent or cause 1.
• The condition is thought to result from an autoimmune response, vascular issues, or undetected infections that trigger inflammatory processes in testicular tissue.

Diagnosis and Management

• Treatment typically involves supportive care with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400-600mg three times daily for 7-10 days to reduce pain and inflammation.
• Bed rest, scrotal support with tight-fitting underwear or an athletic supporter, and ice packs applied to the scrotum for 20 minutes several times daily can help manage symptoms.
• If pain is severe, prescription pain medications may be necessary.
• Patients should seek medical attention if symptoms worsen or don't improve within a few days.
• Ultrasound (US) is the established first-line imaging modality for acute scrotal disease and can be used to diagnose most scrotal disorders when combined with clinical history and physical examination 1.

Important Considerations

• The epididymis is the organ primarily involved in epididymoorchitis, with orchitis developing in 20% to 40% due to direct retrograde spread of infection 1.
• Color Doppler imaging shows increased blood flow corresponding to hyperemia, which is an important diagnostic feature of epididymitis.
• Complete resolution typically occurs within 1-2 weeks with appropriate management.
• Persistent inflammation could lead to complications like testicular atrophy or fertility issues, emphasizing the need for prompt and accurate diagnosis and treatment.

From the Research

Definition and Characteristics

• Nonspecific testicular inflammation refers to inflammation of the testis that is not caused by a specific infection or autoimmune disease.
• The provided studies do not directly define nonspecific testicular inflammation, but they discuss various forms of testicular inflammation, including autoimmune orchitis 2, 3, 4.

Causes and Pathogenesis

• Testicular inflammation can be caused by infection, trauma, or autoimmune reactions 2, 3, 4.
• The pathogenesis of testicular inflammation involves the breakdown of the testicular immune privilege, leading to the infiltration of immune cells and the production of pro-inflammatory mediators 3, 4.
• The testicular immune privilege is a mechanism that protects the testis from immune attacks, but it can be disrupted by various factors, including infection and inflammation 5, 3.

Types of Testicular Inflammation

• Autoimmune orchitis is a type of testicular inflammation characterized by the presence of specific antisperm antibodies (ASA) and testis inflammation 2.
• Experimental autoimmune orchitis (EAO) is a rodent model of chronic testicular inflammation and organ-specific autoimmunity that offers a valuable in vivo tool to investigate the pathological and molecular mechanisms leading to the breakdown of the testicular immune privilege 3, 4.

Clinical Implications

• Testicular inflammation can lead to infertility, aspermatogenesis, and testicular damage 2, 3, 4.
• The diagnosis and treatment of testicular inflammation depend on the underlying cause and may involve immunosuppressive therapy, assisted reproduction, or other treatments 2, 6.