Dr. Douglas Brum
The two major factors are important in deciding the best treatment for orchitis. One is whether the animal is being used for breeding. Breeding animals present a problem, since the orchitis often leads to infertility. Despite therapy, these animals often have damage to the germinal cells of the testes (the cells producing sperm), fibrosis (scarring) of the testicle, and secondary immune destruction of the testicular tissue. These changes may not lead to infertility initially, but over several months, significant decreases in fertility are commonly seen. Additionally if breeding animals are diagnosed with Brucella canis, they should not be used for breeding again since they may be a potential source of infection to other dogs (and rarely for people), despite treatment. Effected animals should be neutered or euthanized. Antibiotics. This is the first part of therapy in cases of bacterial orchitis. Ideally, the choice of antibiotics should be based on culture results of the infected testicle. Prior to having the culture results, good antibiotic choices include clavulanate-amoxicillin, enrofloxacin, or trimethoprim-sulfonamide. Animals with Brucellosis are treated with minocycline, tetracycline or doxycycline in addition to an aminoglycoside.
The other factor to consider when treating orchitis is whether it is an acute or chronic problem. Acute orchitis needs to be treated more aggressively, since the patient is usually in discomfort and is feeling ill. Animals are often brought to the veterinarian as an emergency due to the severe pain, lethargy, or weakness. Treatment may include intravenous antibiotics and fluids, and a longer hospitalization is often needed. With the chronic disease, animals are usually not ill and are brought to the veterinarian either for infertility or chronic intermittent infections. It is generally difficult to improve fertility in these animals. Specific treatment plans include:
Intravenous fluids. IV's may be needed in animals with acute orchitis that are either dehydrated, in shock, or septic (bacterial blood infection). Fluid therapy maintains tissue perfusion, blood pressure and circulatory status in the critical patient.
Anti-inflammatory medication and analgesics. Most commonly, analgesics are administered because orchitis can be a very painful condition. Narcotics, such as butorphanol, are commonly used. Anti-inflammatory drugs can also relieve pain and decrease the swelling, hyperthermia (increased heat) and potential testicular damage caused by the inflammation. Occasionally, in a valuable breeding animal, stronger anti-inflammatory medications or steroids (prednisone) may be used, in an attempt to minimize this associated tissue damage that many times leads to infertility. Steroids may also be used in cases of immune-mediated orchitis, but at higher, or immunosuppressive, doses.
Cold compresses help reduce swelling, heat, and the pain that accompanies acute orchitis. This is most useful when attempting to preserve fertility in the breeding animal, since prolonged exposure to the increased heat will lead to long term testicular tissue injury.
If an animal is not a breeding animal the most effective method of achieving a cure is castration. Castration removes the possibility that an animal will have chronic, recurrent episodes, and allows for the fastest cures. Castration is always advised for the non-breeding animal. In an acute problem the animal should be stabilized first with the appropriate antibiotic and fluid therapy. Once stable, neutering is advised.
If only a single testicle is involved, and the patient is a breeding animal, a unilateral orchiectomy (the removal of only the affected testicle) may be considered. If treated soon enough, and the inflammation in the scrotum is not too severe, fertility might be preserved allowing the animal to be used for breeding again.
Anti-fungal medication may be used in the rare event of a fungal orchitis. Generally these animals have systemic (affecting other organs) disease.