Epididymitis: Causes, Symptoms, and Treatment
Epididymitis is an inflammation of the epididymis, a tube located behind the testicles that stores and transports sperm. When this tube becomes swollen, it can cause testicle pain and further swelling in the testicles.
This infection can occur in people of all ages with testicles but is most common in those aged 20 and older. It usually develops due to bacterial or sexually transmitted infections (STI). When treated with antibiotics, the condition generally improves. Acute epididymitis lasts six weeks or fewer.
Testes are commonly inflamed in most cases, making it difficult to distinguish if the testes, epididymis, or both are inflamed. Healthcare professionals often use the term “epididymal-orchitis” for infections affecting both parts of the reproductive system.
The typical symptom of epididymitis is gradual pain in the epididymis. Consulting a doctor immediately is essential, as other serious diagnoses may have similar symptoms. For instance, testicular torsion involves twisting of the testicles and is a surgical emergency. Fournier’s gangrene, although less common, is an infection in the groin area that can lead to death if untreated. Chronic epididymitis lasts six weeks or more.
Causes of Epididymitis
Two main types of infections cause epididymitis:
Sexually Transmitted Infection (STI)
Epididymitis caused by an STI, such as gonorrhea or chlamydia, is very common in young men, particularly those with multiple sexual partners who do not use condoms.
Cases of epididymitis not caused by an STI are less common.
Urinary Tract Infection (UTI)
Epididymitis caused by a UTI often occurs in children, men who have sex with men, and older men. The following factors frequently contribute to UTIs in men:
- Insertion of a catheter into the penis
- Enlarged prostate pressing on the bladder
- Surgery on the groin, bladder, or prostate gland
Other infections, like the mumps virus and, rarely, tuberculosis, can also cause epididymitis. Sometimes, epididymitis occurs when urine flows backward into the epididymis, possibly due to heavy lifting. Additional causes include:
- Enlarged or infected prostate gland
- Blockage in the urethra
- Catheter usage
- Prostate, urethra, or bladder surgery
- Traumatic groin injury
Medicinal Prevention of Epididymitis
Men aged 21 to 39 are most commonly affected by epididymitis due to STIs. Preventative measures include:
- Practicing safe sex by using condoms
- Limiting sexual activity to one partner
- Maintaining hygiene before and after sexual activity
- Monitoring your partner’s health for STIs
If infected, avoid sexual activity until fully treated and cleared by a doctor. Certain medications for surgeries or other conditions may increase the risk of epididymitis. Be cautious about side effects before consuming any drugs.
Avoid using level 2 antibiotics in young and older male athletes, as these can be hazardous for this demographic.
Prevention of Epididymitis from Infections
Never ignore urinary tract infections. Addressing risk factors early can help prevent recurrence. Maintain good hygiene, especially in the anal area, to avoid chronic epididymitis or epididymal circumcision.
Abnormalities in the urinary tract should be treated early, ideally before puberty, to reduce the risk of infections. Any history of surgery or catheter use should be documented to help identify causative organisms and ensure quick treatment. Prophylactic antibiotics can significantly reduce the risk of bacterial growth leading to epididymitis.
Symptoms of Epididymitis
When a bacterial infection begins, the epididymis becomes gradually swollen and painful, typically affecting one testicle. If untreated, symptoms can last up to six weeks. Symptoms include:
- Fever
- Frequent or urgent need to urinate
- Painful urination or ejaculation
- Lump on the testicle
- Redness, swelling, and tenderness in the scrotum
- Bloody urine
- Discomfort in the lower abdomen
- Enlarged lymph nodes in the groin
When to See a Doctor
Do not ignore scrotal pain or swelling, as some conditions may require immediate treatment to avoid permanent damage. Seek emergency care for severe scrotal pain. If experiencing penile discharge or urinary discomfort, consult a healthcare provider promptly.
How Epididymitis is Detected
Healthcare providers may examine the penis, prostate, and scrotum and ask about symptoms and health conditions. Diagnostic tests may include:
- Blood and urine tests to check for infections
- Fluid sample testing from penile discharge to detect bacteria
- Nuclear scan to assess blood flow in the testicles
- Ultrasound imaging to view testicles and assess blood flow
Treatment
Prompt treatment is essential to prevent complications and STI transmission. Presumptive therapy is often initiated before laboratory results, targeting likely causative organisms. Treatment goals include:
- Curing microbiologic infection
- Improving symptoms
- Preventing STI transmission
- Reducing complications such as infertility or chronic pain
Most cases of acute epididymitis can be treated on an outpatient basis. However, hospitalization or specialist referral may be necessary for severe symptoms such as fever, testicular torsion, or abscesses. Age, diabetes history, and elevated C-reactive protein levels may also indicate more severe conditions requiring hospitalization.
