Epididymitis: Causes, symptoms, and treatment

By Tom Seymour 

Reviewed by Alana Biggers, MD, MPH

In the back of the testicles, there is a coiled tube called the epididymis. This tube stores and carries sperm and is linked to the ejaculatory duct by another tube called the vas deferens.

Epididymitis is when this tube becomes painful, swollen, and inflamed.

There are two types of epididymitis. Acute epididymitis comes on suddenly, and pain and inflammation develop quickly. This kind of epididymitis lasts less than 6 weeks.

Chronic epididymitis develops slowly and has a duller pain. It is a long-term problem that lasts for longer than 6 weeks. Males of any age can be affected by the condition.

If the testicles also become inflamed and painful, then this is known as epididymo-orchitis.

Causes

The spread of a bacterial infection usually causes epididymitis. This infection will often start in the urethra, prostate, or bladder.

Two main types of infection cause epididymitis:

Sexually transmitted infection (STI)

Epididymitis caused by an STI, such as gonorrhea or chlamydia, is most common in young, heterosexual men; particularly those who have sex with multiple partners and do not use a condom.

Cases of epididymitis that are not caused by an STI are less common.

Urinary tract infection (UTI)

Epididymitis caused by a UTI occurs in children, older men, and men who have sex with men. The following factors often cause UTIs in men:

• enlarged prostate pressing on the bladder
• insertion of a catheter into the penis
• surgery on the groin, bladder, or prostate gland

Children

While cases of epididymitis in children are rare, they do occur. Often the bacterial infection will spread from the urethra or bladder.

Inflammation will usually develop due to one of the following:

• direct injury to the area
• twisting of the epididymis
• urine flowing back into the epididymis

Other causes

There are also some more unusual causes of epididymitis:

• mumps
• tuberculosis
• high doses of a medication called amiodarone, usually taken for heart rhythm problems
• groin injury
• structural problems in the urinary tract
• Behcet's disease
• congenital kidney and bladder problems

Symptoms

Epididymitis will cause pain in one or both testicles. The affected area will also be red, swollen, and warm to touch. If it is left untreated, it will worsen over time.

Other symptoms include:

• fever
• chills
• heaviness in the affected testicle
• enlarged testicle
• affected testicle sensitive to touch
• pain in the abdomen or pelvis
• frequent urge to urinate
• burning sensation when urinating
• discharge from the end of the penis
• blood in urine
• pain when ejaculating or having sex
• fluid buildup around the testicle which may feel like a lump

Symptoms will usually depend on the cause of the epididymitis. For example, discharge from the penis is likely to be due to an STI, while the urge to urinate probably results from a UTI.

Symptoms of epididymitis can also be similar to those of testicular torsion, a condition that sees the testicle twist and cut off the blood supply and which requires emergency surgical treatment.

As a result, if a person experiences any of these symptoms they should see a doctor straight away.

In children, the most common symptoms are:

• discomfort in lower abdomen or pelvis
• a red and tender area on the side of the scrotum
• pain or burning when urinating
• discharge from the urethra
• fever

Diagnosis

The doctor will probably have to carry out a physical exam to see if any of the symptoms of epididymitis are present and to check for signs of infection and inflammation.

It can often be hard to tell the difference between epididymitis and testicular torsion, particularly in younger men.

Sometimes epididymitis and testicular torsion can occur at the same time.

Doctors may perform some other tests to find the cause. These include:

• rectal exam, where a doctor inserts a finger into the anus to check for an enlarged prostate
• urine and blood tests
• urine samples to test for gonorrhea and chlamydia
• ultrasound scans, to identify testicular torsion
• medical history

Treatment

Treatment will be provided based on what is causing the epididymitis. If it is a bacterial infection, the doctor will probably prescribe a course of antibiotics.

If the infection was caused by an STI, the man must tell their sexual partners. They will also need to abstain from having sex until the treatment is completed.

As well as this, doctors will probably also recommend painkillers and anti-inflammatory drugs, such as ibuprofen, to reduce pain and swelling.

There are also some basic things that a person can do to reduce discomfort:

• resting lying down with the scrotum elevated
• applying an ice pack to the painful area
• wearing a scrotal support

In general, once treatment has started the pain associated with epididymitis will go within 1 to 3 days. However, some of the symptoms can take months to disappear.

In more severe cases, a person may have to stay in the hospital and may require some surgical procedures.

Follow-up exams with the doctor will also be necessary to make sure the infection has cleared up.

Recovery and outlook

In most cases, epididymitis clears up with antibiotics and bed rest, and there are no long-term sexual or reproductive problems.

However, the condition can return, and some complications can occur:

• abscess in the scrotum, which may require draining
• chronic epididymitis
• opening on the skin of the scrotum
• the death of testicular tissue due to a lack of blood, known as testicular infarction
• infertility

Chronic epididymitis

In the case of chronic epididymitis, doctors will not prescribe antibiotics as inflammation occurs without an infection.

Treatment includes:

• frequent warm baths
• anti-inflammatory medication that does not contain steroids
• medication to relax muscles and alter nerve messages
• anesthetic of steroid injections into the scrotum
• surgery to remove affected epididymis
• stress management techniques

SOURCE: MEDICAL NEWS TODAY