Epididymitis is swelling (inflammation) of the epididymis, the tube that connects the testicle with the vas deferens.
Causes, incidence, and risk factorsEpididymitis 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 an infection from the urethra 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) can occur as 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:
Epididymitis may begin with a low-grade fever, chills, and a heavy sensation in the testicle. The testicle becomes more and more sensitive to pressure.
Other symptoms include:
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:
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.
TreatmentYour 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.
Expectations (prognosis)Epididymitis usually gets better with antibiotic treatment. There usually is no reduction in sexual or reproductive abilities. However, it is common for the condition to 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.
ComplicationsComplications include:
Acute pain in the scrotum is a medical emergency. It needs to be checked out by a health care provider immediately.
Calling your health care providerCall 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.
PreventionYou 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.
ReferencesNickel JC. Inflammatory Conditions of the Male Genitourinary Tract: Prostatitis, and Related Conditions, Orchitis, Epididymitis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 9.