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Epididymitis – Causes, Symptoms and Treatment

Epididymitis is an inflammation of the epididymis, the coiled tube behind the testicle. It is most commonly caused by bacteria and leads to testicular pain and swelling.

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Things worth knowing about "Epididymitis"

Epididymitis is an inflammation of the epididymis, the coiled tube behind the testicle. It is most commonly caused by bacteria and leads to testicular pain and swelling.

What is Epididymitis?

Epididymitis is an inflammation of the epididymis – a small, coiled tube located at the back of each testicle that stores and carries sperm. It is one of the most common urological conditions in men and can occur at any age, though it most frequently affects men between 14 and 35 years of age and men over 50.

In many cases, the inflammation spreads to the testicle itself, a condition known as epididymo-orchitis.

Causes

The most common cause of epididymitis is a bacterial infection. There are two main groups:

Sexually transmitted organisms: In younger, sexually active men, the condition is frequently caused by Chlamydia trachomatis or Neisseria gonorrhoeae (gonorrhea).
Non-sexually transmitted organisms: In older men or those with urinary tract conditions, bacteria such as Escherichia coli are common culprits, typically spreading from the urinary tract.

Other possible causes include:

Urinary tract infections or prostatitis
Urinary catheterization or urological procedures
Rarely: mumps virus (especially in children and adolescents)
In rare cases: tuberculosis or other uncommon pathogens

Symptoms

Symptoms of epididymitis typically develop over a few hours to days and may include:

Severe, often one-sided testicular pain originating from the epididymis
Swelling and redness of the scrotum
Warmth in the affected area
Fever and general feeling of illness
Pain or burning during urination (dysuria) or increased urinary frequency
Occasional urethral discharge (in sexually transmitted cases)

Important note: Sudden, severe testicular pain may also indicate testicular torsion – a medical emergency requiring immediate treatment. Any such symptoms should be assessed by a doctor without delay.

Diagnosis

Diagnosis is typically established through the following assessments:

Physical examination: Palpation of the testicle and epididymis; a positive Prehn sign (relief of pain when the testicle is elevated) may suggest epididymitis.
Ultrasound (scrotal sonography): Visualizes the epididymis and rules out testicular torsion; typically shows an enlarged, hyperemic epididymis.
Urinalysis and urine culture: Detects bacteria and signs of infection in the urine.
Urethral swab: Tests for chlamydia or gonorrhea.
Blood tests: Elevated inflammatory markers (CRP, white blood cell count) support the diagnosis.

Treatment

Treatment depends on the underlying cause:

Antibiotic Therapy

For bacterial epididymitis, antibiotic treatment is the primary approach. The choice of antibiotic depends on the suspected or confirmed pathogen:

For sexually transmitted infections: e.g., doxycycline or ceftriaxone plus doxycycline.
For non-sexually transmitted infections (e.g., enteric bacteria): e.g., fluoroquinolones (ciprofloxacin, ofloxacin) for 10 to 14 days.

Supportive Measures

Bed rest and scrotal elevation to relieve pain and swelling
Cold compresses (ice pack wrapped in a cloth)
Pain-relieving and anti-inflammatory medications (e.g., ibuprofen)

Treatment of Underlying Conditions

Any concurrent urinary tract infection, prostatitis, or sexually transmitted infection should also be treated. When a sexually transmitted organism is identified, sexual partners should be evaluated and treated as appropriate.

Possible Complications

With prompt and appropriate treatment, epididymitis usually resolves completely. However, inadequate or delayed treatment may lead to:

Abscess formation in the scrotum
Chronic epididymitis with persistent pain
Scarring of the vas deferens, potentially impairing fertility
Spread of infection to the testicle (orchitis)

Prevention

The following measures can help reduce the risk of epididymitis:

Using condoms to protect against sexually transmitted infections
Prompt treatment of urinary tract infections and prostatitis
Regular urological check-ups if urinary tract problems are present

References

Trojian TH, Lishnak TS, Heiman D. Epididymitis and orchitis: an overview. American Family Physician. 2009;79(7):583-587.
Centers for Disease Control and Prevention (CDC): Sexually Transmitted Infections Treatment Guidelines – Epididymitis. 2021. Available at: https://www.cdc.gov/std/treatment-guidelines/epididymitis.htm
Nickel JC. Epididymitis. In: Wein AJ et al. (eds.): Campbell-Walsh Urology. 11th edition, Elsevier, 2016.

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