Orchitis – inflammation of the testes

(Also known as dydmitis and linked with Epididymitis: inflammation of the testicular tube where sperm is stored)**

One of my male Wolfhounds (no prizes for guessing which one) was diagnosed with Orchitis at 12 months of age and this article is designed to try and explain what the condition is, how it is caused and how it is treated and to give hope to anyone else unfortunate enough to be in a similar situation. I am not a vet, but this is my own experience as an Irish Wolfhound owner of an issue that can occur in males of any age.

Orchitis /ˌɔrˈkaɪtɪs/ or orchiditis /ˌɔrkɪˈdaɪtɪs/ (from the Ancient Greek ὄρχις meaning "testicle"; same root as orchid) is inflammation of the testes.1 It can also involve swelling, heavy pains and frequent infection, and is more rarely known as didymitis (as in epididymis). [taken from Wikipedia at http://en.wikipedia.org/wiki/Orchitis]

Signs/symptoms We got up one morning to find Presto looking very distressed and seemingly unable to stand up. He was 12 months of age at this point and an ongoing issue with HOD, (which he had been diagnosed with 2 months previously) caused us to think that he had experienced a flare-up of that condition. In addition to the reluctance/inability to stand, he also refused food (again this is unheard of for Presto and we would have to be under nuclear attack for him not to eat his breakfast). Convinced the problem was his affected femurs (long bones in the back legs going from the knee up to the hip) my husband returned home from work and Presto was taken to the veterinary consultant (Graham Oliver of East Midlands Referrals) who had already been treating the HOD. I checked the dog’s temperature and it was high and all discomfort was concentrated around his back legs, but at this point we could not see any other likely causes for his physical state. In other dogs suffering this condition there may also be symptoms such as blood in the urine. However, I should point out that the number 1 symptom is the glaringly obvious one of swelling to the testicles! It took the veterinary consultant and another vet (who happened to be present at the consultation and who was being mentored by the consultant) 30 minutes of examination and prodding and poking before the cause of the problem was discovered. It was actually my husband who pointed out that Presto screamed in pain when his tail was pulled tightly around his bottom and therefore Steve thought the problem must be located in that area and not Presto’s legs or spine (as both vets thought). Sure enough, once Presto had been laid on his back, the right testicle was very swollen and almost glowing red. You can well imagine that the pain associated with Orchitis can be excruciating (for any men reading this article, bet you’re crossing your legs right now and grimacing!).

The most common symptoms are [taken from PetMD website at http://www.petmd.com/dog/conditions/reproductive/cmultiepididymitis_orchitis?page=show#.UdFYKzu1F8E]: · Swollen testicles · Licking of the scrotum and scrotal skin irritation (dermatitis) · Non-localized symptoms include pain and fever · Unwillingness to walk and general lethargy · Open wound may be found · Refusal to eat is not uncommon · Infertility is commonly seen in dogs with this condition

Causes There are 2 main causes of Orchitis (and/or Epididymitis) and these are trauma or infection. In Presto’s case we initially thought that there had been some infection trigger to set off the condition, but this would have had to have been a direct source of infection (in other words an infection that entered through his urethra and lodged in one of the testicles) and we had seen no other indications of that. So we eventually concluded that it had been caused by trauma, the other main trigger for Orchitis. Usually direct trauma occurs to the affected testicle in the form of the dog injuring itself through normal daily activities such as playing or possibly from a bite wound. We could not locate any marks/bites on Presto and so came up with the one and only likely scenario for trauma-induced Orchitis, yes, you guessed it – Presto had been humping our St Bernard! We did speak to other Wolfhound owners at the time to see if anyone else had experienced anything like this before and to our relief we discovered that a friend’s dog had also suffered trauma-based Orchitis after having played with some younger Wolfhounds and one of whom had dived on the male whilst he was laying and rolling around on his back. A huge thank you to Caroline Sheppard for her great support, advice and experience on this topic as, without her invaluable insight, we would have been even more distressed than we were and also would have probably put Presto through a castration surgery that would have turned out to have been completely unnecessary.

Diagnosis As mentioned previously, the diagnosis in Presto’s case was by physical examination by 2 vets and we eventually discovered the very swollen testicle. However, as the outward symptoms also mimic testicular torsion or a testicular tumour, further investigations were carried out to rule these other 2 conditions out. Presto was nlikely, but not ruled out completely (it is vital for the testicle to be checked in this manner as a torsion will cause the die-off of the testicle and potentially be fatal to the dog). We then began the ‘waiting game’ to see if the inflammation and swelling would subside. Caroline had advised us that this could take several weeks, but that Presto should feel much more comfortable after a couple of days of pain relief and antibiotic treatment. This turned out to be exactly what happened. After 2 weeks of very little reduction in the swelling, our vet was concerned that there was still the possibility that Presto could have a testicular tumour so we decided to allow him to operate and open up the testicle. The deal was that if the vet found a tumour then he would remove the testicle and so Presto would be ‘half castrated’. The day before the surgery was due to take place we decided to have Presto checked again as we thought the swelling had gone down and sure enough our vet agreed that it was definitely decreasing in size and so the surgery was cancelled (coupled with the advice from Caroline, we were all happy that things were moving in the right direction and we needed to wait longer).

Treatment Presto was initially given antibiotics (Noroclav 1500mg bid, 6ml Noroclav injection and Clindamycin 1900mg bid) as we were unsure of the cause of the Orchitis and also pain relief through analgesics (Tramadol 100mg qid, Pardale 600mg bid). The medication ensured that he became much more comfortable very quickly, although the actuall swelling of the testicle took much longer to go down. As mentioned previously, an ultrasound scan was also performed to check blood flow to the affected area. Caroline had taken her affected dog to a fertility consultant for examination and she was informed that the swelling would subside and that the testicle may well continue to shrink, ending up significantly smaller than the unaffected testicle – probably to about the size of a walnut, but the other testicle would remain fertile. In Presto’s case the damaged testicle has indeed shrunk and we now have a broad bean look going on!

Summary Presto’s right testicle is hardly visible at all now (4 months on from the initial event), but it can still be located, with a bit of fumbling around and is literally about the size of a broad bean.

We were quite lucky that this turned out the way it has, but once again, I would urge anyone in a similar situation to seek urgent veterinary treatment as the cause of the Orchitis could be torsion or tumour and could need immediate attention to not only save the testicle, but even save the dog’s life. In the interim between this happening to Presto and writing this article, I have already been in communication with another Wolfhound owner whose young male IW displayed identical symptoms, but in that case the ultrasound showed no blood supply as a torsion had occurred and so the dog was castrated. Finally, a huge thank you once again to Caroline Sheppard for all her help during a very trying time and another one of Presto’s great adventures!