Pulling a Flat Out of the Hat – Defining Testicular Atrophy
What Types of STDs Cause Testicular Atrophy?

Pulling a Flat Out of the Hat – Defining Testicular Atrophy

The genitalia has long been considered as a susceptible organ, particularly in our current society, where endowment, appeal, and prowess are just some of the determining characteristics of a seemingly preferable mate.

While it might seem like a very shallow basis of one’s dating and mating compatibility, the sad truth is that even in the available health products within the market, this unfortunate reality is still being reflected through the production of various enhancement supplements, feminine wash, and performance boosters – all of which are designed and marketed with the core idea that the public has a desperate need to show that their private regions are, for the lack of a better word, pleasant to behold.

This particular issue further translates into the medical field wherein surgeries designed to make the appearance of the genitalia more appealing are becoming more and more popular – a horrifying fact that widely represents the condition that society has ultimately boiled down to. While it is not necessarily a bad thing that the current community is now putting more interest and effort into maintaining the unit downstairs, it is not exactly the most pleasant news to hear, especially when you realize that years ago, humanity envisioned the 2020s as something very advanced and futuristic – not exactly genitalia-centric like how the social mechanics are nowadays.

Moving back to the main issue that this outline is trying to put forward, the immense focus of our society on the appearance of the genitalia has now made it even more critical for people to realize that certain conditions can alter the overall appearance of this particular organ. While rare in most aspects, some conditions could make the genitalia swell, some could develop warts that the genitalia almost looks crusted, some could cause disfigurement due to the immense damage caused by blisters, and some could cause changes in the original morphology of the organ in such a way that some parts of it almost seem to shrink.

This latter situation is relatively evident in men, known as testicular atrophy or testicular shrinkage. The change in shape can be caused by several reasons, some of which are, obviously, sexually transmitted. Contrary to what most people might assume, considering that the effect is widely located in the genital region, not all underlying disease that causes testicular atrophy is sexually transmitted. An intrinsic consequence of the body causes some, some are caused by trauma, and some are caused by infections – sexually and non-sexually transmitted alike.

In assessing whether a particular STD causes your testicular atrophy, it is essential to know how to distinguish one condition over the other, especially considering that the symptoms of several diseases have been previously known to overlap with each other. While it might be true that a pertinent laboratory test is still necessary for a conclusive diagnosis, it does not necessarily mean that awareness regarding the condition will get you nowhere.

Testicular Atrophy: What Is It?

Testicular atrophy, more commonly known as testicular shrinkage, is the tendency of testes – the parts of your genitalia that appear like a hanging area with two elliptic glands – to shrink and decrease in size following a particular event that has been found to cause effects in the size of testes. The testes itself is not the whole part as it is only the two glands within the skin sac known as the scrotum. While this might seem important from the very fact that it is attached right next to the shaft of the penis, what you might want to note is that this is the part that is widely responsible for the production of your sperm – making it the part that will dictate your fertility, along with other corresponding factors, of course, that are associated with the body’s ability to reproduce.

There are several potential reasons behind the testes' tendency to shrink, some of which are caused by one’s natural aging pattern. However, in some instances, there are cases where the shrinkage is caused by one’s habits, an underlying condition that you were previously unaware of, and lastly, an infection that could affect the main genitalia along with its internal structures.

Natural or Caused by a Disease?

As previously mentioned, there are several causes of testicular atrophy. Its mechanism and origin may be considered multi-faceted so that multiple factors might even cause it at once. While it might be possible for patients to have a shrunken testicular area due to old age, some diseases can affect this organ, particularly in cases where the patient is still too young to experience any intrinsic shrinkage of the testes age. What is even more concerning with the presence of this symptom in young individuals is that testicular atrophy is often associated with a low sperm count, lower testosterone levels, or both – resulting in issues with one’s fertility, stamina, performance, libido, and overall quality of health.

Is Testicular Shrinkage Linked to an STD?

Testicular shrinkage does possess the common stereotypical signs that an underlying sexually transmitted infection causes a symptom, but it is not always associated with a disease, much less a sexually transmitted one to begin with. However, one must also assess their risk factors for this question to be answered as this would heavily rely on what you are exposed to, what intrinsic factors are present that could put you at greater risk, and what other considerations can be made to associate the condition with a particular root cause fully.

Potential Non-STD Causes of Testicular Atrophy

To understand what other conditions may cause testicular atrophy, the following are the common non-STD causes of testicular shrinkage, outlining their common characteristics and additional necessary information that may even be beneficial in creating a differential that would further narrow down one’s potential root cause. However, note that this does not encourage self-medication, and an immediate physician’s consultation remains the best option there is when this particular symptom manifests.

Old Age

A particular part of their reproductive cycle in female patients, especially as they approach old age, is known as menopause. This stage essentially signals that their fertility is about to come at its end, and their hormones then adjust to accommodate this change in their reproductive pattern. In male patients, however, while this specific cycle is not particularly evident, there is what is known as andropause, wherein the testicular levels of the patient drop – causing both behavioral and physical changes, primarily characterized by the shrinkage of testicles or testicular atrophy. While the patient can reproduce following their peak reproductive years, they would tend to produce less sperm following that stage and observe less of the benefits that testosterone usually brings forth for the body.

Testicular Cancer

Testicular cancer is a relatively common type of cancer among men of all ages, particularly at an average age of 33. It mainly affects young and middle-aged men, and the symptoms appear relatively early, albeit it is rather hard to recognize until a corresponding physical exam is performed or the subtle changes are observed by either you or your physician. Among the early symptoms, the following manifestations are most common: sharp pain in the testicle or scrotum, a heavy feeling inside the scrotum, and a difference in size between the testicles of the patient. Due to these changes in the testicles of the patient, they may also experience hormonal changes that may result in the growth and soreness of the breast muscles in the affected individual. Lower back pain, difficulty breathing, abdominal pain, headaches, confusion, and a lump in the testicle may likewise be included among the list of possible symptoms observed in a patient found to have testicular cancer.

Orchitis

Orchitis is essentially rooted in an infection in the testicles, resulting in the precipitation of pain and inflammation within the testicular area. This is commonly caused by either a bacterial or viral infection, and the following causes are some of the most common there are for men, which results in similar manifestations:

Urinary Tract Infection

A urinary tract infection or UTI is essentially harmless in most cases due to how infections usually commonly situate themselves within the urinary tract instead of the reproductive ducts. However, severe and chronic conditions may result in the colonization of the testicular area, resulting in the development of an infection within the testes.

STD Infection

Similar to how UTIs behave, STDs are also mainly situated with the genitalia area. They can likewise migrate to other locations and internal structures if the condition is not managed correctly. Especially with chronic lifelong STDs, the risk for migration is far more significant and should be continuously monitored.

Intestinal Bacteria Intrinsic Infection

When men have sex with someone of the same sex, anal intercourse is usually implied – a process that increases the risk significantly for the displacement of common intestinal bacteria and resulting in the invasion of these pathogenic microorganisms in the penetrative partner’s reproductive ducts. Upon invasion, the intrinsic flora that would generally maintain the health of the bowel will prove to be harmful as it replicates within the urethra and the testes of the patient, resulting in inflammation and pain within the affected region.

Surgery

While rare, surgical procedures, especially invasive ones involving the genital area (vasectomy, for instance), could pose the risk of a post-operative infection within the patient's testes. Although rare, considering that the sterilization and aseptic measures being employed in hospitals and operating rooms are usually airtight, it is an imminent possibility and should therefore be looked out for in cases where the genital area has been opened for a particular procedure.

Catheter Use

The use of catheters essentially inserts a long tube within the urethra of a male patient – meaning that professionals are intentionally introducing a foreign object into one of the most sensitive areas of the body. While this is rare, similar to how post-op infections are uncommon in surgeries, contamination is always a possible risk and should therefore be likewise monitored to prevent any further worsening of any symptom that might present following invasion.

Mumps

Being a condition common among young men, mumps is well-known for its prevalence among men of young age and for its tendency to cause the side of the face to swell up – mainly due to the inflammation of the salivary glands upon contracting the condition. However, based on several studies, it has been found that orchitis or inflammation of the testicles usually begins 4 to 6 days following the first presentations of mumps, followed by testicular atrophy as the inflammation subsides.

Overuse of Alcohol

According to various studies, ethanol and its overuse has been linked with multiple reproductive functions and sexual behavior problems, primarily pointing towards problems associated with a patient’s semen production and sperm quality. In line with this, chronic and acute use of alcohol has also been linked to reduced testosterone levels, testicular atrophy, and irregularity in the semen ducts of the patient.

Testicular Torsion

Testicular torsion is essentially a condition where the patient’s spermatic cord becomes twisted, resulting in a cut-off blood supply. With the lack of sufficient blood flow to the entire genitalia, it is estimated that testicular shrinking is evident if the supply is not restored within 6 hours following the incident and that the testes itself could die or be “infarcted” if the blood supply is not restored hours after that.

Varicocele

Varicocele is defined as the enlargement of the veins within the scrotum, the patch of skin the holds your testicles together. It is essentially a varicose vein located in the genitalia. It has been found to cause low sperm production, decreased semen quality, failure for the testicles to develop normally, and of course, testicular atrophy.

Sexually Transmitted Conditions that are Potential Causes of Testicular Atrophy

If you are currently suspecting that an underlying sexually transmitted infection causes your condition, the following outline will provide a more detailed differential guide that you can use to get a more profound outlook into what is behind your presentations.

Syphilis

Manifestations

Syphilis, a condition caused by the pathogen known as Treponema pallidum, is considered as an STD that is infamous for its tendency to develop severe health sequelae if the condition is not immediately treated and is left without any management strategy entirely for years. While it might seem like the presentations are relatively mild, especially during its early primary and secondary stages where the only thing that one might observe is the presence of syphilitic sores known as chancres, the manifestations get progressively worse as the patient moves through the different stages – causing systemic presentations during its secondary stage and affecting several other organs such as the brain, nerves, eyes, heart, blood vessels, liver, brain, bones, and joints in the tertiary stage of the condition. It is also possible to transmit the disease to the baby during labor if the mother was positive during labor – requiring that mothers be tested before undergoing delivery to ensure that the baby is safe, and all prophylactic medications are already available if the mother’s infection could not be resolved immediately.

Testing

Treponemal tests are usually indicated for the diagnosis of Syphilis as treponemal antibodies are detected earlier than nontreponemal antibodies, and they typically remain detectable for life – removing the temporal aspect necessary in other tests indicated for the same condition. However, non-treponemal tests are also prescribed to patients as a confirmatory step due to the tendency of treponemal tests to return positive if the patient has been previously infected and cured of Syphilis.

Treatment Procedure

The general treatment regimen for Syphilis is 2.4 million units of Benzathine Penicillin G administered intramuscularly in a single dose for most cases, but some more specific formulations are provided for particular cases. For instance, 7.2 million units in total of the same medication are administered in 3 equally spaced doses for patients with late latent Syphilis or Latent Syphilis of unknown duration.

Chlamydia

Manifestations

Chlamydia, on the one hand, is a relatively common sexually transmitted infection in the US and the world as its prevalence is fairly consistent (increasing and decreasing intermittently) among the at-risk population. It is considered as the silent infection due to how widely asymptomatic it behaves in most cases, but conditions in men would often be described with the following manifestations:

  • Mucoid or watery urethral discharge
  • Dysuria
  • Epididymitis
    • Unilateral testicular pain
    • Tenderness in the testes
    • Swelling of the genitalia

In some cases, Chlamydia may likewise affect the rectum in both men and women through both receptive and penetrative anal sex, and this usually results in symptoms such as rectal pain, discharge, and bleeding.

Testing

Nucleic acid amplification tests or NAATs are the most preferred diagnostic tool for Chlamydia due to their sensitivity and use of easily-obtainable specimens such as vaginal swabs and urine. However, note that cell culturing is still employed in specific contexts due to accessibility issues in something as complex as a NAAT.

Treatment Procedure

As a treatment procedure, the Centers for Disease Control and Prevention recommends either a 7-day dose of antibiotics or a single-dose antibiotic designed to address Chlamydial infections. This is likewise coupled with abstinence throughout the treatment period to avoid further transmission of the disease to the patient’s partner.

Gonorrhea

Manifestations

Gonorrhea, a sexually transmitted infection caused by the pathogen Neisseria gonorrhoeae, mainly targets the mucous membranes of the genitalia and other parts of the body. While it is most common in the genitalia, it can likewise cause infections in the rectum, throat, eyes, and mouth – presenting with the following symptoms in most of its manifestations:

  • Dysuria
  • White, yellow, or green urethral discharge
  • Epididymitis
    • Testicular pain
    • Scrotal pain
  • Increased vaginal discharge
  • Vaginal bleeding between periods
  • Anal itching and soreness
  • Painful bowel movements

Testing

Similar to how Chlamydia cases are diagnosed, NAATs or nucleic acid amplification tests are likewise preferred for diagnosing Gonorrhea, especially in the case of urogenital Gonorrhea. However, specific FDA-cleared tests for rectal and oral cases are utilized instead in these contexts as these are the most effective procedures among these situations.

Treatment Procedure

According to the Centers for Disease Control and Prevention, the recommended treatment regimen for Gonorrhea is 500 mg of intramuscularly administered Ceftriaxone single dose. Do note, however, that the administration of antibiotics will no longer resolve the damage that has been caused by the infection and will only be able to resolve the issue of the pathogen’s presence within the patient’s system.

Testing Options for Potential STD Infections

If you suspect that a potential STD is causing the changes in the size of your testicular area, then the following testing laboratories may be able to help you in narrowing down the next steps that you should take in addressing your condition. Do note, however, that this does not encourage self-medication in any way. Instead, it simply empowers information dissemination and the education of the public to help them make more informed decisions about their healthcare needs.

Laboratory

Chlamydia

Syphilis

Gonorrhea

Package Prices

What it Offers

STD Check Labs

Yes

Yes

Yes

Custom Kit at $148.00

  • Waiting time is approximately 1-2 days
  • On-site sample collection to avoid contamination of testing sample
  • Kit can be customized to include other STDs to your liking
  • Various kits available depending on your needs

myLAB Box

Yes

Yes

Yes

8-Panel Kit at $269.00

  • 2 day waiting time at the minimum
  • Samples can be collected in the comfort of your own home for utmost privacy
  • Sample contamination is possible but avoidable if instructions are followed
  • Comprehensive kits available for testing other STDs as well

HealthLabs

Yes

Yes

Yes

Comprehensive STD Panel at $1139.00

  • 3-day waiting time for results
  • Transactions are performed remotely to maximize the privacy of the patient
  • Minimal interaction with other people to ensure maximum privacy

GetTested (CDC)

Yes

Yes

Yes

Free to use

  • A website developed by the CDC to allow patients to look for available testing laboratories within their respective areas.

Frequently Asked Questions (FAQs)

Is there an observed foul odor in Chlamydia infections?

Yes. Although it could not be described by one particular description, it can be characterized as a strong, unusual odor emanating from the affected areas of the body.

How long does it usually take for Gonorrhea symptoms to ease following treatment?

Based on the evidence, the discomfort caused by an infection should improve within 2-3 days following the start of treatment, but the course should be continued to ensure that the condition is entirely resolved.

Is it possible to get Gonorrhea again following an infection despite not being exposed?

No. It is possible to be reinfected, but it requires a second exposure to an infected individual.

Is it possible to obtain false-positive results for Syphilis?

Yes. RPR tests for Syphilis have been found to produce false-positive results in certain instances.

How long should a patient with Syphilis wait before having sexual contact again?

To be safe, a patient should wait for at least ten days following the resolution of all sores before any sexual contact occurs to avoid any potential transmission.

Further Reading

National Institute of Allergy and Infectious Diseases

StatPearls

World Health Organization

References

Mark Riegel, MD

Latest Stories

Here’s what we've been up to recently.

Concerned about an STD?

Help stop the spread of STDs by knowing your status. Get tested today!