Epididymitis

Epididymitis

Definition:

Epididymitis is an inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm. Pain and swelling are the most common signs and symptoms of epididymitis. Males of any age can get epididymitis, but it's most common in men between the ages of 14 and 35.

Epididymitis is most often caused by a bacterial infection or by a sexually transmitted infection (STI), such as gonorrhea or chlamydia. In some cases, the testicle also may become inflamed — a condition called epididymo-orchitis.


Symptoms:

Epididymitis symptoms depend on the cause. They can include:

• A tender, swollen, red or warm scrotum
• Testicle pain and tenderness, usually on one side — the pain may get worse when you have a bowel movement
• Painful urination or an urgent or frequent need to urinate
• Painful intercourse or ejaculation
• Chills and a fever
• A lump on the testicle
• Enlarged lymph nodes in the groin (inguinal nodes)
• Pain or discomfort in the lower abdomen or pelvic area
• Discharge from the penis
• Blood in the semen

Chronic epididymitis
Signs and symptoms of epididymitis usually develop over a day or two and get better with treatment. In some cases, epididymitis may not clear up completely or may recur. This is known as chronic epididymitis. Symptoms of chronic epididymitis may come on gradually. Sometimes the cause of chronic epididymitis is not identified.

When to see a doctor
Never ignore scrotal pain or swelling. A number of conditions can cause testicular pain, and some of the conditions require immediate treatment. Some conditions that cause scrotal pain or swelling can get worse or cause permanent damage if not treated promptly.

Testicular torsion, caused by a twisted spermatic cord, can cause pain similar to that caused by epididymitis and requires emergency treatment because it blocks blood flow to the testicle.
See a doctor if you have discharge from your penis or pain when you urinate


Causes:


Epididymitis has a number of causes, including:

• Sexually transmitted infections (STIs). STIs, particularly gonorrhea and chlamydia, are the most common cause of epididymitis in young, sexually active men.
  
• Other infections. Boys, older men and homosexual men are more likely to have epididymitis caused by a nonsexually transmitted bacterial infection. For men and boys who've had urinary tract infections or prostate infections, bacteria may spread from the infected site to the epididymis. Rarely, epididymitis is caused by a fungal infection.
  
• The heart medication amiodarone (Pacerone). In some cases, this anti-arrhythmic medication causes inflammation of the epididymis. Epididymitis caused by amiodarone is treated by temporarily discontinuing the drug or reducing the dose.
  
• Tuberculosis. In some cases, tuberculosis can cause epididymitis.
  
• Urine in the epididymis. Known as chemical epididymitis, this occurs when urine flows backward into the epididymis. It may occur with heavy lifting or straining.

Epididymitis:

Epididymitis may eventually cause:

• Scrotal abscess, when infected tissue fills with pus
• Chronic epididymitis, which can occur when untreated acute epididymitis leads to recurrent episodes
• Shrinkage of the affected testicle (atrophy)
• Reduced fertility, but this is rare

If the condition spreads from your epididymis to your testicle, the resulting condition is known as epididymo-orchitis. Signs, symptoms and treatment options are basically the same as they are for epididymitis.


Treatments and drugs:

Epididymitis caused by a sexually transmitted infection (STI) or other infection is treated with antibiotic medications. Your sexual partner will also need treatment. Make sure your doctor is aware of any other medications you're taking or any allergies you have. This information, as well as determining what type of infection you have, will help your doctor select the best treatment.

Be sure to take the entire course of antibiotics prescribed by your doctor, even though you may feel better in one to three days after you start treatment. If you're not feeling better in that time, contact your doctor.

When you've finished your medication, it's a good idea to return to your doctor for a follow-up visit to be sure that the infection has cleared up. If it hasn't, your doctor may try another antibiotic. If the infection still doesn't clear, your doctor may do further tests to determine whether your epididymitis is caused by something other than a bacterial infection or an STI.

If a pocket of pus (abscess) has formed, it may need to be drained, and in some cases part or all of the epididymis needs to be removed surgically (epididymectomy). Surgery may also be considered if epididymitis is due to underlying physical defects, but many people continue to have scrotal pain following epididymectomy.