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
si2188 testicle
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Causes

This condition is most often caused by a bacterial infection. For example:Other causes include:

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

You will be asked about your symptoms and medical history. A physical exam will be done. Your bodily fluids may be tested. This can be done with:
  • Urinalysis
  • Urine culture
  • Culture or other test of discharge from penis
  • Blood tests
Images may be taken of your scrotum. This can be done with ultrasound.

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.
  • 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.

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

Health Canada
http://www.hc-sc.gc.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 guide: 2006. MMWR. 2006;55. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/std/treatment/2006/rr5511.pdf. Accessed September 24, 2014.

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

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

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