EPIDIDYMITIS

WHAT IS EPIDIDYMITIS?

Epididymitis is inflammation of your epididymis, a coiled tube at the back of your testicle that stores and carries sperm. This swelling can cause intense testicular pain. Epididymitis is most often caused by a bacterial infection, including sexually transmitted infections (STIs), such as gonorrhea or chlamydia. Sometimes, a testicle also becomes inflamed — a condition called epididymo-orchitis.

WHAT ARE THE SYMTPOMS OF EPIDIDYMITIS?

Symptoms of epididymitis might include:

• A swollen, discolored or warm scrotum
• Testicle pain and tenderness, usually on one side, that often comes on slowly
• Pain when you pass urine
• An urgent or frequent need to urinate
• Discharge from the penis
• Pain or discomfort in the lower abdomen or pelvic area
• Blood in the semen
• Less commonly, fever

WHAT CAUSES EPIDIDYMITIS?

Most cases of epididymitis are caused by an infection called E. coli. Some cases happen from bacteria called Mycoplasma or Chlamydia. These infections often come by way of sexually transmitted infections.

Other infections, including the mumps virus and rarely, tuberculosis, can also cause epididymitis.

Sometimes, epididymitis occurs when pee (urine) flows backward into your epididymis. This can happen as a result of heavy lifting. Other epididymitis causes include:

• Blockage in your urethra (the tube that carries pee from your body).

• An enlarged or infected prostate gland (a muscular, walnut-sized gland that surrounds part of your urethra).
• Use of a catheter (a tube that drains your bladder).
• Surgery on the prostate, urethra or bladder.
• Traumatic groin injury.

Certain sexual behaviors that can lead to STIs put you at risk of sexually transmitted epididymitis, including having:

• Sex with a partner who has an STI
• Sex without a condom
• Anal sex
• A history of STIs

WHAT ARE THE RISK FACTORS?

Risk factors for epididymitis that’s not sexually transmitted include:

• Having a prostate or urinary tract infection
• Having a medical procedure done that affects the urinary tract, such as insertion of a urinary catheter or scope into the penis
• An uncircumcised penis
• A difference in the typical anatomy of the urinary tract
• Prostate enlargement, which increases the risk of bladder infections and epididymitis
• Other health conditions that cause a weakened immune system, such as HIV

WHAT ARE THE COMPLICATIONS?

Complications of epididymitis include:

• Pus-filled infection, called an abscess, in the scrotum
• Collection of fluid around the testicle, called a hydrocele
• Epididymo-orchitis, if the condition spreads from the epididymis to a testicle
• Rarely, reduced fertility

WHAT ARE THE PREVENTIONS?

To reduce your risk of epididymitis, you should:

• Use condoms during sex.
• Avoid strenuous lifting or physical activity.
• Minimize long periods of sitting.

CAN YOU GET EPIDIDYMITIS WITHOUT HAVING AN STD?

Yes. You can get epididymitis through non-sexually transmitted infections. For example, prostate or urinary tract infections can spread to your epididymis.

HOW DO WE DIAGNOSE EPIDIDYMITIS IN OUR FACILITY

To diagnosis epididymitis, we will talk to you about your symptoms and also examine your groin. This includes checking for enlarged lymph nodes in your groin and an enlarged testicle on the affected side. Your provider also might do a rectal exam to check for prostate enlargement or tenderness.

Tests may include:

• STI screening. A narrow swab inserted into the end of your penis collects a sample of any discharge you may have. The sample is checked in the lab for gonorrhea and chlamydia.
• Urine and blood tests. Samples of your urine and blood may be sent to the lab for testing, too.
• Ultrasound. This imaging test uses sound waves to create pictures of your testicles. The test can show if you have testicular torsion. Testicular torsion is a twisting of the testicle that can cut off blood flow. If ultrasound with color Doppler shows lower blood flow to a testicle than is typical, the testicle is twisted. If blood flow is higher than typical, this can help confirm that you have epididymitis.

HOW DO WE TREAT EPIDIDYMITIS IN OUR FACILITY?

Treatment for epididymitis often includes antibiotics and comfort measures. Sometimes, surgery may be needed.

Antibiotics

Antibiotics are needed to treat bacterial epididymitis and epididymo-orchitis — epididymitis infection that has spread to a testicle. If the cause of the bacterial infection is an STI, any sex partners also need the treatment. Take all of the antibiotic medicine prescribed by us, even if your symptoms clear up sooner. This helps make sure that the infection is gone.

Comfort measures

You should start to feel better after 2 to 3 days on an antibiotic, but it may take several weeks for pain and swelling to go away. Resting, supporting the scrotum with an athletic supporter, applying ice packs and taking pain medicine can help relieve discomfort.

We may want to see you at a follow-up visit to check that the infection is gone and your symptoms have improved.

Surgery

If an abscess has formed, you might need surgery to drain it. Sometimes, all or part of the epididymis needs to be removed surgically. This surgery is called an epididymectomy. Surgical repair might be done when underlying problems with the anatomy of the urinary tract lead to epididymitis.

WILL EPIDIDYMITIS GO AWAY?

With proper treatment, epididymitis will go away. It’s important to seek treatment as soon as possible to avoid further complications.

WHAT CAN HAPPEN IF EPIDIDYMITIS IS LEFT UNTREATED?

An epididymitis infection can lead to serious problems if it’s not treated in a timely manner. Chronic epididymitis could cause an abscess to form on your scrotum. Or it could destroy your epididymis, resulting in infertility. In some cases, the infection can spread to other parts of your body.

HOME REMEDIES

Epididymitis often causes a lot of pain. Try these tips to ease your discomfort:

• Rest in bed.
• Lie down so that your scrotum is elevated.
• Apply cold packs to your scrotum as tolerated.
• Wear an athletic supporter.
• Avoid lifting heavy objects.
• Avoid sex until your infection has cleared.