Viral Orchitis - Fact or Fiction?

• Applicant: Professor Dr. Adrian Pilatz
• Subject Area: Reproductive Medicine, Urology ; Virology
• Term: from 2019 to 2022
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 425976748

• Final Report Year: 2023

Final Report Abstract

Orchitis is an inflammation of one or both testicles. While chronic inflammation is typically a histological diagnosis in the course of a testicular biopsy in cases of male infertility, acute orchitis is accompanied by painful swelling of the affected testicles. This affects approximately 15 per 100,000 men per year, making it around the same incidence as testicular cancer. Although various viruses are considered to be the clinical cause for acute orchitis, it is completely unclear to what extent and which viruses are etiologically involved in acute orchitis. Furthermore, it is unknown what the clinical course of the disease is and what the impact is on male fertility. Therefore, a prospective study was set up in 2007 to decipher acute isolated orchitis. Between July 2007 and February 2023, a total of 26 patients with isolated orchitis were managed and compared to 530 men who suffered acute epididymitis, which is usually caused by urinary tract infection with bacteria. We were able to show for isolated orchitis, that 1) orchitis is usually of viral origin (20/26, 77%) and enteroviruses with coxsackievirus B strains (16/26, 62%) are predominant, 2) virus isolates could be received from semen indicating presence of replication competent virus particles, 3) a PCR for enteroviruses should be conducted using semen provided at the onset of disease, because the virus is not detectable in serum/urine, 4) there is a circannual occurrence with maximum in summer, 5) orchitis is associated with a characteristic inflammatory cytokine panel in the semen and systemic inflammation, 6) orchitis is usually rapidly self-limiting, and 7) about 30% of patients (6/20) suffer ongoing reduced sperm concentration in semen (oligozoospermia). This is likely to fundamentally change thinking and clinical practice about acute isolated orchitis. In particular, patients with acute orchitis must have an early semen collection after improvement of pain symptoms so that virologic diagnosis for enteroviruses can be performed to clarify the cause of acute orchitis.

Publications

• Virusinfektionen in der Urologie. Der Urologe, 60(9), 1150-1158.
  Magistro, G.; Pilatz, A.; Schneede, P.; Schneidewind, L. & Wagenlehner, F.
  
• Acute orchitis deciphered: Coxsackievirus B strains are the main etiology and their presence in semen is associated with acute inflammation and risk of persistent oligozoospermia. Journal of Medical Virology, 95(7).
  Pilatz, Adrian; Arneth, Borros; Kaiser, Rolf; Heger, Eva; Pirkl, Martin; Böttcher, Sindy; Fritzenwanker, Moritz; Renz, Harald; Mankertz, Annette; Schuppe, Hans‐Christian & Wagenlehner, Florian
  
• Comprehensive evaluation of hematospermia in patients with acute epididymitis compared to patients with isolated hematospermia. Andrology, 12(5), 1001-1011.
  Dittmar, Florian; Rosellen, Jens; Reiser, Leo; Fritzenwanker, Moritz; Hauptmann, Arne; Diemer, Thorsten; Schuppe, Hans‐Christian; Wagenlehner, Florian & Pilatz, Adrian