Chronic scrotal content pain and viral orchiepididymitis: an overlooked hypothesis linking infection and Wallerian degeneration

BACKGROUND: Chronic scrotal content pain (CSCP) is a challenging clinical condition, often undiagnosed, and marked by persistent or intermittent pain that may be localized or generalized and significantly affect quality of life. Wallerian degeneration, an inflammatory process involving axonal degeneration, may underlie the mechanism. While bacterial infections are recognized contributors to CSCP, the role of viral infections is less understood. METHODS: We systematically searched PubMed, MEDLINE, and Web of Science for studies reporting associations between viral infections and scrotal or testicular pain. Of 142 identified records, 61 met the inclusion criteria and were analyzed qualitatively. RESULTS: Our review assesses whether testicular or epididymal viral infections might contribute to CSCP. The literature points to a possible link, though definitive histopathological evidence remains scarce. Tissue biopsies may provide greater diagnostic clarity and inform treatment decisions. CONCLUSIONS: Additional research is needed to understand how viral infections affect testicular function, semen quality, and fertility, to improve patient outcomes globally.