title: Diagnosis and classification of autoimmune orchitis.
abstract: Autoimmune orchitis is characterized by testis inflammation and the presence of specific antisperm antibodies (ASA). It is classified in two categories. Primary autoimmune orchitis is defined by infertility and asymptomatic orchitis associated with ASA (100%) directed to the basement membrane or seminiferous tubules in infertile men, without any systemic disease and usually asymptomatic. Secondary autoimmune orchitis is characterized by symptomatic orchitis and/or testicular vasculiti`s associated with a systemic autoimmune disease, particularly vasculitis. These patients typically demonstrate testicular pain, erythema and/or swelling. ASA in secondary autoimmune orchitis have been reported in up to 50% of patients, especially in systemic lupus erythematosus patients. The pathogenesis of primary as well as secondary autoimmune orchitis is still unknown. Although the etiology is likely to be multifactorial, testicular inflammation, infection or trauma may induce T cell response with pro-inflammatory cytokine production with a consequent blood-testis-barrier permeability alteration, ASA production and apoptosis of spermatocytes and spermatids. ASA is known to cause immobilization and/or agglutination of spermatozoa, which may block sperm-egg interaction resulting in infertility. Assisted reproduction has been used as an efficient option in primary cases and immunosuppressive therapy for secondary autoimmune orchitis, although there is no double-blind, randomized trial to confirm the efficacy of any treatment regimens for these conditions.
authors.affiliation: Pediatric Rheumatology Unit, Department of Pediatric, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. Electronic address: clovis.silva@hc.fm.usp.br.
authors.forename: C A
authors.initials: CA
authors.lastname: Silva
authors.affiliation: Human Reproduction Center and Department of Andrology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: M
authors.initials: M
authors.lastname: Cocuzza
authors.affiliation: Division of Rheumatology, Federal University of Bahia, Bahia, Brazil.
authors.forename: J F
authors.initials: JF
authors.lastname: Carvalho
authors.affiliation: Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: E
authors.initials: E
authors.lastname: Bonfá
mesh_terms: D000818:Animals; D001327:Autoimmune Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology / Q000628:therapy; D001706:Biopsy; D001814:Blood-Testis Barrier / Q000473:pathology; D006801:Humans; D008297:Male; D009920:Orchitis / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology / Q000628:therapy; D013094:Spermatozoa / Q000276:immunology / Q000473:pathology; D013601:T-Lymphocytes / Q000276:immunology / Q000473:pathology
keywords: Antisperm antibodies; Autoimmune orchitis; Fertility; Rheumatic diseases; Testicle