Epididymitis

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 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.

Another cause of epididymitis is the use of a medicine called amiodarone, which prevents abnormal heart rhythms.

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

Epididymitis may begin with a low fever, chills, and a feeling of heaviness in the testicle area. The area will get more sensitive to pressure and 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
• Fever
• Lump near the testicle
• 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

Physical exam will show a red, tender lump on the affected side of the scrotum. Tenderness is most often centered 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 also be enlarged, and there may 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

This condition may appear like testicular torsion, in which the blood supply to the testicle is cut off. It is important to make the distinction because testicular torsion is an emergency. Surgery is needed as soon as possible in a case of testicular torsion..

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

If the condition is caused by taking amiodarone, you will need to lower your dose or change your medicine.

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 health care provider to make sure the infection has cleared completely.

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.

Complications include:

• Abscess in the scrotum
• 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 health care professional right away.

Call your health care 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.

You can prevent complications from epididymitis by getting diagnosed and treated early.

Your doctor may prescribe antibiotics before a surgery that could raise the risk for epididymitis. Practicing safe sex (including avoiding multiple sexual partners and using condoms) may help prevent epididymitis caused by sexually-transmitted diseases.