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Epididymitis

(Epididymo-orchitis)

Definition

Acute epididymitis is an inflammation of the epididymis. This is a structure that surrounds and attaches to each testicle. It is shaped like a tube. The epididymis helps transport and store sperm cells.
Chronic epididymitis causes discomfort or pain in the epididymis. It can last for three months or longer. This type is less common.
The Epididymis
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Causes

This condition is most often caused by a bacterial infection. For example:
Other causes include:
  • Injury
  • Viral infections, such as mumps
  • Genital abnormalities
  • Treatment with amiodarone (Cordarone), a heart rhythm drug
  • Chemotherapy to treat bladder cancer

Risk Factors

Only men can develop this condition. Risk factors include:
  • Age: 15-30 (sexually transmitted bacteria is a common cause)
  • Age: over 60 (urinary tract infections are a more frequent cause)
  • Infection of the genitourinary tract (urethra, bladder, kidney, prostate, or testicle)
  • Narrowing of the urethra
  • Use of a urethral catheter
  • Infrequent emptying of the bladder
  • Recent surgery or instrumentation of the genitourinary tract (especially prostate removal )
  • Birth defects of the genitourinary tract
  • Unprotected sex
  • Disease that affects the immune system
Children and newborns can get epididymitis. It is not necessary to have a urinary tract infection.

Symptoms

Symptoms usually develop within one day. These include:
  • Pain in the testicles
  • Sudden redness or swelling of the scrotum
  • Hardness, a lump, and/or soreness in the affected testicle
  • Tenderness in the nonaffected testicle
  • Groin pain
  • Chills
  • Fever
  • Inflammation of the urethra
  • Pain during intercourse or ejaculation
  • Pain and/or burning during urination
  • Increased pain while having a bowel movement
  • Lower abdominal discomfort
  • Discharge from the penis

Diagnosis

Your doctor will ask about your symptoms and medical history. He or she will do a physical exam. Tests may include:
  • Urinalysis—to check for high white blood cell (WBC) count and the presence of bacteria
  • Urine culture —to identify the type of bacteria present
  • Culture or other test of discharge from penis
  • Blood test—to measure the WBC count
  • Ultrasound—a test that uses sound waves to examine the scrotum

Treatment

Treatment is essential to prevent the infection from worsening. Treatment may include:
  • Bed rest—This keeps the testicles from moving and promotes healing. You may need bed rest until the swelling goes away.
  • Antibiotics—You will be given antibiotics to treat a bacterial infection. Many cases of epididymitis are caused by sexually transmitted bacteria. Chlamydia is one of the most common. If you have an STD , your partner(s) will also need treatment. Take all of your antibiotics, even if you begin to feel better.
  • Oral anti-inflammatory medication—This includes drugs like ibuprofen , to help reduce swelling.
  • Scrotal elevation and support—You may need to wear an athletic supporter for several weeks.
  • Hot baths—Taking baths can ease the pain and help relieve swelling.
  • Surgery—May be needed in severe cases that keep coming back.
Do not have sex until you and your partner have completed treatment.
If you are diagnosed with epididymitis, follow your doctor's instructions .

Prevention

The following steps can help decrease your risk:
  • Practice safe sex. Protect yourself from STDs by using condoms .
  • Empty your bladder as soon as you feel the need.

RESOURCES

National Kidney Foundation http://www.kidney.org

Urology Care Foundation http://www.urologyhealth.org

CANADIAN RESOURCES

Canadian Health Network http://www.canadian-health-network.ca

The Kidney Foundation of Canada http://www.kidney.ca

References

Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR . 2010;59(No. RR-12):1-110.

Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2006: epididymitis. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/std/treatment/2006/epididymitis.htm . Updated April 12, 2007. Accessed July 15, 2010.

Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guide: 2006. MMWR . 2006;55. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/std/treatment/2006/rr5511.pdf . Accessed February 5, 2008.

Hori S, Sengupta A, et al. Long-term outcome of epididymectomy for the management of chronic epididymal pain. J Urol . 2009 Oct;182(4):1407-1412.

The Merck Manual of Diagnosis & Therapy . 17th ed. Rahway, NJ: Merck & Co; 1999.

Santillanes G, Gausche-Hill M, et al. Are antibiotics necessary for pediatric epididymitis? Pediatr Emerg Care . 2011 Feb 19.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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