Introduction
Orchitis is an inflammatory condition of one or both testes. Orchitis can be caused by either bacterial or viral infections or by unknown etiology. Autoimmune orchitis is an autoimmune disorder characterized by inflammation of the testis and specific anti-sperm antibodies that are present in the serum of the patient. It causes pain and infertility in males. The presence of specific anti-sperm antibodies may cause harmful effects on male sperms affecting their number and inducing certain abnormalities. These antibodies can also affect fertility in males. However, the hypothalamus-pituitary-gonadal axis is not disturbed thereby leading to normal secretion of
male hormones which include follicular stimulating hormone, luteinizing hormone, testosterone, and inhibin B hormone.
What Is the Classification of Autoimmune Orchitis?
Autoimmune orchitis is usually classified into two types:
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Primary autoimmune orchitis.
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Secondary autoimmune orchitis.
a)Primary Autoimmune Orchitis- It is characterized by male infertility where the condition is usually asymptomatic. There is no evidence of any systemic diseases with the anti-sperm specific antibodies being directed towards the seminiferous tubules of the testis.
b) Secondary Autoimmune Orchitis- It is also characterized by male infertility issues along with pain in the testicles, redness, and swelling of the testis. There is evidence of testicular vasculitis along with the presence of systemic autoimmune disease.
What Are the Clinical Features of Autoimmune Orchitis?
The disease is most frequently seen in young male adults. It is likely to affect those males who do not have previous exposure to any kind of inflammation or infection. Patients suffering from acute autoimmune orchitis typically demonstrate severe scrotal pain, edema, testicular swelling, erythema, tenderness, and high fever. Some patients exhibit mild tenderness in the testicles along with subtle testicular membrane thickening and scrotal swelling. However, in subacute or chronic autoimmune orchitis cases, most of the patients remain asymptomatic. Secondary autoimmune orchitis is a rare disease and is usually associated with primary vasculitis. It is usually associated with the following diseases:
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Prostatitis (inflammation of the prostate gland).
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Behcet’s disease (inflammatory disease affecting the blood vessels of the body).
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Polyarteritis nodosa (a type of vasculitis causing injury to various organs).
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Systemic lupus erythematosus (a type of lupus causing widespread tissue and organ damage).
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Idiopathic inflammatory myopathy (inflammation of the skeletal muscles).
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Relapsing polychondritis (recurrent inflammation of the cartilaginous tissues).
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Rheumatoid arthritis (inflammation of the joints).
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Ulcerative colitis (inflammatory bowel disease).
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Systemic scleroderma (a type of systemic disease causing tightening of the skin).
Other clinical features of the disease include:
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Tiredness.
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Chills.
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Severe headache.
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Myalgia (muscle pain).
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Nausea and vomiting.
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Increased heartbeat (tachycardia).
What Are the Complications of Autoimmune Orchitis?
Complications of autoimmune orchitis include:
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Atrophy of Testicles- The affected testicles might shrink due to orchitis in the chronic phase.
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Scrotal Abscess- The scrotal tissue may become infected and gets filled with pus.
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Infertility in Males- Autoimmune orchitis can cause permanent infertility in males.
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Hypogonadism- This condition occurs when the gonads (sex glands) of the body are not able to secrete sufficient hormones or no hormones at all.If the disease is left untreated, it may lead to inadequate production of the testosterone hormone. But the condition is less likely to occur if only one testicle is involved.
How Is Autoimmune Orchitis Diagnosed?
The diagnosis is usually made by examining the clinical manifestations of the disease by the healthcare professional. Autoimmune orchitis is categorized into primary and secondary autoimmune orchitis.
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Semen Parameters- The sperm count, sperm motility, and morphology can be carried out but they are not specific to the disease. Sometimes, they are present in the normal range. Therefore, other confirmatory tests are required.
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Anti-sperm Antibodies Evaluation- Infertility caused due to autoimmune response is characterized by the anti-sperm antibodies present in the serum or in the seminal fluid or on the sperm surface. In the normal state, the testes are immunologically privileged to tolerate the antigens. However, in cases of infection or injury, the controlled mechanism of the testis can be disturbed thereby leading to anti-sperm antibody production. The anti-sperm antibody formation can induce an autoimmune-mediated testicular inflammation. Hence, it is important to detect the anti-sperm antibodies by the immunobead binding test (this test detects the presence of antibodies on the sperm surface using beads that are coated with IgA, IgG, and IgM).
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Imaging Tests- Testicular ultrasonography can be carried out to measure the amount of blood flow in the testicles. Magnetic resonance imaging can also be carried out.
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Biopsy- In cases of secondary orchitis, a fine core biopsy can be performed to detect autoimmune changes in the testis.
What Is the Treatment of Autoimmune Orchitis?
Acute autoimmune orchitis is usually treated with analgesics (pain killers), an ice pack wrapped in a towel, the elevation of the scrotum, and complete bed rest. Local anesthetics can be given in the form of nerve blocks (one percent Lignocaine) around the spermatic cord in individuals who are suffering from severe pain. In cases of infections, antibiotics can be administered.
Secondary autoimmune orchitis is usually managed by medications such as glucocorticoids, and immunosuppressive agents.
Avoid having sexual contact and lifting heavy-weight objects to prevent further damage to the testes.
What Is the Prognosis of Autoimmune Orchitis?
Most people suffering from autoimmune orchitis recover completely. Infertility issues and other long-term complications are very rare to occur. To improve the prognosis of the condition, the patient should immediately visit the healthcare professional if he is having fever and chills, severe scrotal pain and swelling, and idiopathic muscle pain.
Conclusion
Autoimmune orchitis causes direct aggression to the males’ testes due to the presence of anti-sperm antibodies. Autoimmune orchitis is a systemic inflammatory condition that can cause severe pain in the testes and scrotal swelling along with the presence of anti-sperm antibodies in the serum. Currently, there is no specific treatment standardized for the management of the condition and also the role of anti-sperm antibodies affecting male fertility has not been well elucidated. Researchers should do more studies to identify more effective diagnostic and therapeutic modalities. There is a need to integrate more data on this health disorder and establish a standardized treatment for this autoimmune systemic disease.
