What is epididymitis?

Definition

Acute epididymitis is an
inflammation of the epididymis. This is a structure shaped like a tube that surrounds and attaches to each testicle. The epididymis helps transport and store sperm cells.

Chronic epididymitis causes pain and inflammation in the epididymis. There is often no swelling of the scrotum. Symptoms can last six weeks or more, but this type is less common.

Causes

Epididymitis is most often caused by bacterial infections such as those of
the urinary tract, by sexually transmitted diseases (STDs)
such as chlamydia and gonorrhea, by infection of the urethra
(urethritis), by infection of the prostate (prostatitis),
and by tuberculosis. Other causes include injury, viral infections
such as mumps, genital abnormalities, treatment with the heart rhythm drug
amiodarone (cordarone), and chemotherapy to treat bladder cancer.

Risk Factors

Risk factors for epididymitis include infection of the genitourinary tract (bladder, kidney, prostate, or testicle), narrowing of the urethra, use of a urethral catheter, infrequent emptying of the bladder, recent surgery or instrumentation of the genitourinary tract (especially prostate removal), birth disorders of the genitourinary tract, unprotected sex, and disease that affects the immune system. Most at risk are boys and men ages fifteen to thirty years and men older than age sixty years.

Symptoms

Symptoms usually develop within a day and include pain in the testes; sudden redness or swelling of the scrotum; hardness, a lump, or soreness (or all three) in the affected testicle; tenderness in the nonaffected testicle; groin pain; chills; fever; inflammation of the urethra; pain during intercourse or ejaculation; pain or burning, or both, during urination; increased pain while having a bowel movement; lower abdominal discomfort; discharge from the penis; and blood in the semen.

Screening and Diagnosis

A doctor will ask about symptoms and medical history and will perform a physical exam. Tests may include a urinalysis to check for a high white blood cell (WBC) count and the presence of bacteria; a urine culture to identify the type of bacteria present; a culture of discharge from the penis; a blood test to measure the white blood cell count (WBC); and an ultrasound (a test that uses sound waves to examine the scrotum).

Treatment and Therapy

Treatment is essential to prevent the infection from worsening. Treatment may
include bed rest. The patient should stay in bed to keep the testicles from moving
and to promote healing. Bed rest might be necessary until the swelling subsides.
Another treatment is antibiotics, prescribed for bacterial
infections. If the patient has an STD, his partners will also need treatment.
Another treatment is oral anti-inflammatory medication, which includes drugs such
as ibuprofen, to help reduce swelling.

The patient may need to wear an athletic supporter for several weeks. Taking baths can ease the pain and help relieve swelling. One should not have sex until treatment is completed. Finally, surgery may be needed in severe cases that return.

Prevention and Outcomes

To help decrease the risk of developing epididymitis, one should practice safer sex. One can protect against STDs by using condoms. Finally, one should empty one’s bladder when feeling the need to do so.

Bibliography

Centers for Disease Control and Prevention. “Sexually Transmitted Diseases Treatment Guidelines 2010.”Available at http://www.cdc.gov/std/treatment/ 2010.

Lunenfeld, Bruno, and Louis Gooren, eds. Textbook of Men’s Health. Boca Raton, Fla.: Parthenon, 2007.

National Institutes of Health. “Men’s Health.” Availableat http://health.nih.gov/category/menshealth.

Schrier, Robert W., ed. Diseases of the Kidney and Urinary Tract. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2007.

Simon, Harvey B. The Harvard Medical School Guide to Men’s Health. New York: Free Press, 2004.