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by Badash M

Epididymitis

(Epididymo-orchitis)

Definition

The epididymis is a tiny, looped tubule that sits on the back of the testicle. The tubule stores sperm and makes a path for sperm to pass out of the body. Epididymitis is an inflammation of the epididymis. It may be:
  • Acute—short lasting with treatment, often caused by infection
  • Chronic—lasts longer than 6 weeks or keeps coming back (less common); cause is not always clear
The Epididymis
si2188 testicle
Copyright © Nucleus Medical Media, Inc.

Causes

Epididymitis is most often caused by an infection but can also be caused by an injury.
  • An infection may spread from a nearby structure. This may happen with a urinary tract infection or sexually transmitted disease (STD).
  • Injuries may be as a result of trauma or medical treatment such as chemotherapy or local surgery.
Sometimes the cause is not clear.

Risk Factors

Only men can develop this condition but it can affect males of any age.
Infections that may lead to epididymitis include:
Other problems that may increase the risk of epididymitis include:
  • Use of a urethral catheter
  • Trauma
  • Recent surgery in the area such as prostate removal or vasectomy
  • Chemotherapy to treat bladder cancer
  • Birth defects of the genitourinary tract
  • Disease that affects the immune system
  • Treatment with amiodarone, a heart rhythm drug

Symptoms

Symptoms will depend on the cause but can 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 unaffected testicle
  • Pain and/or burning during urination
  • Discharge from the penis
  • Pain during intercourse or ejaculation
  • Lower abdominal discomfort
  • Pain may spread to the groin
  • Fever or chills
Symptoms of chronic epididymitis may start more gradually.

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Epididymitis may be suspected based on the physical exam. Tests may be done to look for the underlying cause. These may include:
  • Urine tests
  • Urine culture
  • Urethral swab
  • Blood tests
  • Tissue tests
  • Testicular ultrasound

Treatment

Treatment is important to prevent permanent damage. The specific treatment will depend on the cause. Options include:
Rest and support:
  • Bed rest may be needed until the swelling has decreased.
  • Use of athletic supporter for several weeks to elevate and support the scrotum.
Medication such as:
  • Antibiotics to treat a bacterial infection
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and swelling
If an STD is diagnosed, sexual partner(s) will need to be notified and treated.
Surgery may be needed for severe chronic epididymitis.

Prevention

To help reduce your chances of epididymitis:
  • Practice safe sex. Protect yourself from STDs by using condoms.
  • Empty your bladder as soon as you feel the need. This may help decrease the risk of urinary tract infections.

RESOURCES

National Kidney Foundation
https://www.kidney.org
Urology Care Foundation
http://www.urologyhealth.org

CANADIAN RESOURCES

Health Canada
https://www.canada.ca
The Kidney Foundation of Canada
https://www.kidney.ca

References

2015 Sexually transmitted diseases treatment guidelines. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/std/tg2015/default.htm. Updated January 25, 2017. Accessed October 9, 2017.
Acute epididymitis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114552/Acute-epididymitis. Accessed October 6, 2017. Accessed October 9, 2017.
Hori S, Sengupta A, Shukla CJ, Ingall E, McLoughlin J. Long-term outcome of epididymectomy for the management of chronic epididymal pain. J Urol. 2009;182(4):1407-1412.
Santillanes G, Gausche-Hill M, Lewis RJ. Are antibiotics necessary for pediatric epididymitis? Pediatr Emerg Care. 2011;27(3):174-178.

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