Epididymitis

Answer 1

Definition

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

Causes, incidence, and risk factors

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 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:

• 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. The testicle 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 painthat gets worse during a bowel movement

Signs 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.

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.

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.

Calling your health care provider

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

Nickel 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.

Answer 2

Definition

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

Causes, incidence, and risk factors

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 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:

• 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 painthat gets worse during a bowel movement

Signs 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.

Expectations (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.

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.

Calling your health care provider

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

Nickel 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.

Reviewed By

Review Date: 08/13/2010

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., Inc.