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    Epididymitis

    Epididymitis is swelling (inflammation) of the epididymis, the tube that connects the testicle with the vas deferens.

    Causes

    Epididymitis is most common in young men ages 19 - 35. It is a major cause of hospital admissions in the military.

    Epididymitis is usually caused by the spread of a bacterial infection from the urethra, prostate,or the bladder. The most common infections that cause this condition in young heterosexual men are gonorrhea and chlamydia. In children and older men,E. coli and similar infections are much more common. This is also true in homosexual men.

    Mycobacterium tuberculosis (TB) cancause epididymitis. Other bacteria (such as Ureaplasma) may also cause the condition.

    Another cause of epididymitis is the use of a medication called amiodarone, which prevents abnormal heart rhythms.

    The following increase the risk for epididymitis:

    • Being uncircumcised
    • Recent surgery or a history of structural problems in the urinary tract
    • Regular use of a urethral catheter
    • Sexual intercourse with more than one partner and not using condoms

    Symptoms

    Epididymitis may begin with a low-grade fever, chills, and a heavy sensation in the testicle area. The area becomes more and more sensitive to pressure.

    Other symptoms include:

    • Blood in the semen
    • Discharge from the urethra (the opening at the end of the penis)
    • Discomfort in the lower abdomen or pelvis
    • Fever
    • Groin pain
    • Lump in the testicle
    • Pain during ejaculation
    • Pain or burning during urination
    • Painful scrotal swelling (epididymis is enlarged)
    • Tender, swollen groin area on affected side
    • Testicle pain that gets worse during a bowel movement

    Exams and Tests

    Physical examination shows a red, tender, and sometimes swollen lump (mass) on the affected side of the scrotum. Tenderness is usually in a small area of the testicle where the epididymis is attached.

    There may be enlarged lymph nodes in the groin area (inguinal nodes), and a discharge from the penis. A rectal examination may show an enlarged or tender prostate.

    These tests may be performed:

    • Complete blood count (CBC)
    • Doppler ultrasound
    • Testicular scan (nuclear medicine scan)
    • Urinalysis and culture (you may need to give several specimens, including initial stream, mid-stream, and after a prostate massage)
    • Tests for chlamydia and gonorrhea

    It is important to distinguish this condition from testicular torsion. Testicular torsion is an emergency and should be treated with surgery as soon as possible.

    Treatment

    Your health care provider will prescribe medications to treat the infection. Sexually-transmitted infections require specific antibiotics. Your sexual partners should also be treated. You may need pain medications and anti-inflammatory medications.

    The treatment for epididymitis caused by the medication amiodarone is a lower dose or change in the medication.

    Bed rest, while elevating the scrotum and applying ice packs to the area, is recommended. It is very important to have a follow-up visit with your health care provider to find out whether the infection has gone away completely.

    Outlook (Prognosis)

    Epididymitis usually gets better with antibiotic treatment. There usually is no reduction in sexual or reproductive abilities. However, the condition may return.

    If not treated, or in some other cases, the condition can become long-term (chronic). In chronic cases, there is usually no swelling, but there is pain.

    Possible Complications

    Complications include:

    • Abscess in the scrotum
    • Chronic epididymitis
    • Fistula on the skin of the scrotum (cutaneous scrotal fistula)
    • Death of testicular tissue due to lack of blood (testicular infarction)
    • Infertility

    Acute pain in the scrotum is a medical emergency. It needs to be checked out by a health care provider immediately.

    When to Contact a Medical Professional

    Call your health care provider if you develop symptoms of epididymitis. Go to the emergency room or call the local emergency number (such as 911) if you have severe testicle pain suddenly or after an injury.

    Prevention

    You can prevent complications from epididymitis by getting diagnosed early, and by treating any infections.

    Your doctor may prescribe antibiotics before a surgery that increases the risk for epididymitis. Practicing safe sex (having intercourse with only one partner at a time, using condoms) may help prevent epididymitis caused by sexually-transmitted diseases.

    References

    Geisler GM. Diseases caused by chlamydiae. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 326.

    Nickel JC. Inflammatory Conditions of the Male GenitourinaryTract: Prostatitis, and Related Conditions, Orchitis, Epididymitis. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 11.

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    • Male reproductive anatom...

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    • Blood in semen

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    • Pathway of sperm

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    • Male reproductive system

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      • Male reproductive anatom...

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      • Blood in semen

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      • Pathway of sperm

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      • Male reproductive system

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      Self Care

        Tests for Epididymitis

          Review Date: 8/30/2012

          Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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