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Epididymitis

 

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

Causes

Epididymitis is most common in young men ages 19 to 35. It is most often caused by the spread of a bacterial infection. Infection often begins in the urethra, the prostate, or the bladder. Gonorrhea and chlamydia infections are most often the cause of the problem in young heterosexual men. In children and older men, it is more commonly caused by E coli and similar bacteria. This is also true in homosexual men.

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

Amiodarone is a medicine which prevents abnormal heart rhythms. This medicine can also cause epididymitis.

The following increase the risk for epididymitis:

  • Recent surgery
  • Past structural problems in the urinary tract
  • Regular use of a urethral catheter
  • Sexual intercourse with more than one partner and not using condoms
  • Enlarged prostate

Symptoms

 

Epididymitis may begin with:

  • Low fever
  • Chills
  • Feeling of heaviness in the testicle area

The testicle area will get more sensitive to pressure. It will become painful as the condition progresses. An infection in the epididymis can easily spread to the testicle.

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
  • Lump near the testicle

Less common symptoms are:

  • Pain during ejaculation
  • Pain or burning during urination
  • Painful scrotal swelling (epididymis is enlarged)
  • Tender, swollen, and painful groin area on affected side
  • Testicle pain that gets worse during a bowel movement

Symptoms of epididymitis may be similar to those of testicular torsion, which requires emergent treatment.

 

Exams and Tests

 

Physical exam will show a red, tender lump on the affected side of the scrotum. You may have tenderness in a small area of the testicle where the epididymis is attached. A large area of swelling may develop around the lump.

The lymph nodes in the groin area may be enlarged. There may also be discharge from the penis. A rectal exam 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

 

Treatment

 

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

If you are taking amiodarone, you may need to lower your dose or change your medicine. Talk with your provider.

To ease discomfort:

  • Rest lying down with the scrotum elevated.
  • Apply ice packs to the painful area.

You will need to follow-up with your provider to make sure the infection has cleared completely.

 

Outlook (Prognosis)

 

Epididymitis most often gets better with antibiotic treatment. There are no long-term sexual or reproductive problems in most cases. However, the condition may return.

 

Possible Complications

 

Complications include:

  • Abscess in the scrotum
  • Long-term (chronic) epididymitis
  • Opening on the skin of the scrotum
  • Death of testicular tissue due to lack of blood (testicular infarction)
  • Infertility

Sudden and severe pain in the scrotum is a medical emergency. You need to be seen by a provider right away.

 

When to Contact a Medical Professional

 

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

 

Prevention

 

You can prevent complications if you get diagnosed and treated early.

Your provider may prescribe antibiotics before a surgery. This is because some surgeries could raise the risk for epididymitis. Practice safe sex. Avoid multiple sexual partners and use condoms. This may help prevent epididymitis caused by sexually transmitted diseases.

 

 

References

Geisler GM. Diseases caused by chlamydiae. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 318.

Nickel JC. Inflammatory and pain conditions of the male genitourinary tract. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 13.

 
  • Male reproductive anatomy

    Male reproductive anatomy - illustration

    The male reproductive structures include the penis, the scrotum, the seminal vesicles and the prostate.

    Male reproductive anatomy

    illustration

  • Blood in semen

    Blood in semen - illustration

    The presence of blood in semen (the fluid discharged upon ejaculation) may be caused by inflammation, infection, obstruction or trauma.

    Blood in semen

    illustration

  • Pathway of sperm

    Pathway of sperm - illustration

    The testes are where sperm are manufactured in the scrotum. The epididymis is a tortuously coiled structure topping the testis, and it receives immature sperm from the testis and stores it several days. When ejaculation occurs, sperm is forcefully expelled from the tail of the epididymis into the deferent duct. Sperm then travels through the deferent duct through up the spermatic cord into the pelvic cavity, over the ureter to the prostate behind the bladder. Here, the vas deferens joins with the seminal vesicle to form the ejaculatory duct, which passes through the prostate and empties into the urethra. When ejaculation occurs, rhythmic muscle movements propel the sperm forward.

    Pathway of sperm

    illustration

  • Male reproductive system

    Male reproductive system - illustration

    The male reproductive system, viewed from a sagittal section.

    Male reproductive system

    illustration

    • Male reproductive anatomy

      Male reproductive anatomy - illustration

      The male reproductive structures include the penis, the scrotum, the seminal vesicles and the prostate.

      Male reproductive anatomy

      illustration

    • Blood in semen

      Blood in semen - illustration

      The presence of blood in semen (the fluid discharged upon ejaculation) may be caused by inflammation, infection, obstruction or trauma.

      Blood in semen

      illustration

    • Pathway of sperm

      Pathway of sperm - illustration

      The testes are where sperm are manufactured in the scrotum. The epididymis is a tortuously coiled structure topping the testis, and it receives immature sperm from the testis and stores it several days. When ejaculation occurs, sperm is forcefully expelled from the tail of the epididymis into the deferent duct. Sperm then travels through the deferent duct through up the spermatic cord into the pelvic cavity, over the ureter to the prostate behind the bladder. Here, the vas deferens joins with the seminal vesicle to form the ejaculatory duct, which passes through the prostate and empties into the urethra. When ejaculation occurs, rhythmic muscle movements propel the sperm forward.

      Pathway of sperm

      illustration

    • Male reproductive system

      Male reproductive system - illustration

      The male reproductive system, viewed from a sagittal section.

      Male reproductive system

      illustration

    Self Care

     

       

      Review Date: 10/4/2016

      Reviewed By: Jennifer Sobol, DO, urologist with the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

      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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