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Epididymitis

Definition

The epididymis is a looped tube that sits on the back of the testicle. The tube 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
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Causes

Epididymitis is most often caused by an infection but can also be caused by an injury.

  • The infections may start in nearby areas such as a urinary tract infections or sexually transmitted infections.
  • 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, 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. To find a cause or look for other health issues the doctor may also test:

  • Urine:
    • Urinalysis—look for abnormal items in the urine
    • Urine culture—look for signs of an infection
  • Discharge from penis—to look for signs of infection and specific cause
  • Blood—to look for abnormalities

Images may be also taken of your scrotum. This can help confirm the diagnosis and look for any other abnormalities. This can be done with 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 infections. Partner(s) may also need treatment.
    • Oral anti-inflammatory medication—to help reduce swelling.
  • Surgery—may be needed for severe chronic epididymitis

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. This may help decrease the risk of urinary tract infections.

Revision Information

  • National Kidney Foundation

    http://www.kidney.org

  • Urology Care Foundation

    http://www.urologyhealth.org

  • Health Canada

    http://www.hc-sc.gc.ca

  • The Kidney Foundation of Canada

    http://www.kidney.ca

  • Acute epididymitis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114552/Acute-epididymitis. Accessed May 23, 2016. Accessed September 23, 2016.

  • 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 August 31, 2015.

  • 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.

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