Who Does Epididymitis Affect?

Epididymitis most commonly affects young men ages 19 to 35.⁴ People who engage in risky sexual behaviors have a higher chance of undergoing this condition.

What Causes Epididymitis?

The causes of epididymitis vary depending on factors such as age and behavior. The most common cause of epididymitis in all ages is the spread of a bacterial infection that often begins in the urethra, prostate gland, or bladder.⁴ Epididymitis can be caused by both sexually and nonsexually transmitted bacterial infections.⁵

In children who have not yet experienced puberty, the condition is typically linked with a birth-related abnormality that predisposes these individuals to UTIs.¹ In young heterosexual men, gonorrhea and chlamydia are the most common causes of epididymitis.⁴ In these cases, the STIs affect the urethra, resulting in urethritis, before moving into the testicle. If the infection remains untreated, it spreads into the epididymis.³ In homosexual men and older men over the age of 40, Escherichia coli (the bacterium responsible for the onset of UTIs) infections are the most common cause of epididymitis.⁴ Another common cause of epididymitis in older men is obstruction or partial blockage of the urethra due to enlargement of the prostate gland. Sometimes a prostate infection remains asymptomatic until it spreads to the epididymis.³

Other possible causes of epididymitis are:

• Trauma: an injury to the groin or scrotum. This may also include recent surgery.⁵
• Chemical Epididymitis: the backflow of sterile urine into the epididymis, rather than flowing out of the body through the urethra. In these cases, the urine causes the epididymis to become inflamed without any infection. This condition may be the result of heavy lifting or straining.³
• Amiodarone (Pacerone): a type of heart medication that prevents abnormal heart rhythms.⁴ Inflammation of the epididymis is a common side-effect when using this medication. Both amiodarone and chemical epididymitis are usually less severe than other forms of epididymitis.
• Mycobacterium Tuberculosis (TB): tuberculosis infections can cause epididymitis. Unlike the other possible causes, this bacterial infection typically begins in the bloodstream before spreading to the epididymis. However, bacterial epididymitis is rarely caused by TB infections.³

Risk Factors

• Engaging in sexual activities with a partner who has a sexual transmitted infection (STI)
• Engaging in sexual activities as an individual with an untreated STI
• Engaging in sexual intercourse with more than one partner⁴
• Having sex without a condom
• Being the penetrative partner during anal intercourse
• Having a personal history of STIs⁵

Other nonsexual factors that increase one’s risk of nonsexually transmitted epididymitis include:

• Having a history of urinary tract infections (UTIs)
• Having undergone recent surgery, especially medical procedures that affect the urinary tract
• Experiencing prostate enlargement, or other prostate-related problems, which increase one’s risk for UTIs
• Having an uncircumcised penis⁵
• Having a previous history of structural problems in the urinary tract
• Regularly using a ureteral catheter⁴

Symptoms

Early diagnosis and treatment of epididymitis can help manage the symptoms and may prevent further progression of the condition. If you have any of these symptoms, please consult your doctor immediately!

The most common symptoms of epididymitis are pain and swelling of the groin or scrotum. When the infection first spreads to the epididymis, initial symptoms include low fever, chills, and an unusually heavy feeling in the testicle area. As the condition worsens, the affected area becomes more pressurized and sensitive, resulting in increased pain levels. If epididymitis remains untreated, the infection can easily spread to the testicle.⁴ In many cases, pain the scrotum is the only noticeable symptom.³

Other possible symptoms of epididymitis include:

• Unusual warmth, redness, and/or swelling of the scrotum
• Pain and tenderness on one or both sides of the testicle
• Testicular pain that worsens during bowel movements⁴
• Burning, painful, and/or frequent urination
• Discharge from the urethral opening of the penis
• Blood in one’s semen
• Painful intercourse
• Painful ejaculation
• The appearance of a lump on the testicle
• Enlargement of the lymph nodes in the groin
• Pain or discomfort in the lower abdominal or pelvic area
• Fever or chills⁵
• Vomiting³

If these symptoms constantly reoccur or continue to affect the individual for longer than six weeks, the condition is considered chronic.⁵ The symptoms of chronic epididymitis typically increase gradually in severity and are more localized than acute epididymitis.³ Sexually transmitted acute epididymitis is frequently asymptomatic (expresses no symptoms).

If you are experiencing any of the symptoms listed above or think you may have this condition, it is best to consult an urologist (or doctor that specializes in urinary problems) for an accurate diagnosis and proper treatment.⁵ For the safety of your partner(s), avoid having sexual intercourse until you can be examined by a doctor.¹ Never ignore scrotal or urinary pain and swelling! If the pain is sudden and severe, seek emergency treatment from a healthcare professional right away!⁵

Preparation for Your Appointment

If you believe you have epididymitis, and it is not sudden or severe, schedule an appointment with your healthcare provider to get an accurate diagnosis.

Before your appointment takes place, there are several steps you can take to ensure that you provide your doctor with the most accurate information and receive the most effective treatment.

First, write down all of the signs and symptoms that you have experienced, including the duration and progression of pain or swelling, prior to your visit. Be sure to list all issues and symptoms experienced, even if it seems unrelated to this condition.⁵

Additionally, make a list of the dosages and directions for all of the current medications you are taking. This is especially important if you are going to a new healthcare provider. It may be more convenient to just bring the original medication bottles to your appointment.⁶

Please note that communication with your doctor should not be one-way. If you are seeing a new doctor for the first time, it is acceptable to interview your doctor before you are treated to ensure that he or she meets your specific needs.⁷ Do not hesitate to ask questions if you do not understand something your doctor has said or if you have other concerns. It may be useful to prepare some questions before your appointment as well.

When speaking to your doctor about epididymitis, some questions to ask that may be helpful include:

• What is the most likely cause of my symptoms?
• What kind of tests will I need to take?
• What is the best treatment available for me?
• How much time will it take for the treatment to improve my symptoms?
• Can I have sexual intercourse? Are there any restrictions to my sexual activity that I should follow?
• Should my partner(s) be tested for STIs?
• Should I make any lifestyle changes?
• Could there be any side effects from taking my medication?
• What should I do if my symptoms worsen or do not improve?⁵

Diagnosis

In order to receive an accurate diagnosis, the doctor will most likely begin by asking you numerous questions about your condition and medical history before completing a physical examination. These questions may involve the start, progression, and pain level of your symptoms. The doctor may also request a urine sample or take a swab of the urethra to assess the type of bacterial infection (which are usually UTIs or STIs). A rectal examination may be necessary if prostate enlargement is suspected.⁵

If the pain associated with this condition appeared suddenly and severely, rather than gradually, an ultrasound may be needed during the diagnosis to rule out testicular torsion.³ If this condition remains untreated, testicular viability might be compromised and permanent damage may occur.²

Although epididymitis rarely spreads from the bloodstream, the doctor may also ask for a blood test to check for elevated white cell counts and possible tumors. If there is a decrease in blood flow to the testicle, urgent surgical treatment is required.¹

Treatment

Untreated epididymitis can progress into chronic epididymitis or cause other severe complications. These complications may consist of the following:

• Development of abscesses (or pus-filled infections) in the scrotum
• Spreading of the infection into the testicle, causing epididymo-orchitis
• Reduced fertility (though this is a rare complication)⁵
• Perforation or breaking of the scrotal skin
• Death of testicular tissue due to a lack of blood flow into the testicle⁴

Epididymitis most often improves with antibiotic treatment. To treat bacterial epididymitis, your doctor may prescribe at least two weeks of oral antibiotic medication to fight off the infection. If the doctor determines that your condition was caused by an STI, your partner(s) will also need treatment.⁵ Epididymitis caused by a tuberculosis infection is treated with anti-tuberculous medications. To treat amiodarone epididymitis, one must reduce use of (or completely stop using) their heart medication.³

Depending on the severity of your symptoms, the doctor may also prescribe pain and/or anti-inflammatory medications to help provide relief. You can relieve pain with bed rest, keeping the scrotum elevated, supporting the scrotum with an athletic strap, and applying ice to the affected area.⁴

It may take up to several weeks after the start of antibiotics for pain and other symptoms to completely go away. Be sure to finish the entire prescription of antibiotics medication regardless of any change in symptoms, to ensure that the infection is no longer present. Do not forget to follow-up with your doctor a few days after your initial appointment to ensure that the infection is completely gone.⁵ Although feelings of discomfort can persist even after you have taken antibiotics, contact your physician if there is no improvement in the redness within three days.³

In many cases, epididymitis clears up within three months of taking antibiotics. However, if the infection remains present after taking antibiotics or the symptoms do not fully disappear, your doctor may prescribe a secondary antibiotic or suggest surgery.⁵

Unfortunately, treatment for chronic epididymitis is an on-going process because it cannot be cured. You may either need to take medication for many years or undergo surgical treatment. Surgery is often required if the epididymitis caused severe damage.³ Surgery is also considered in cases where epididymitis is caused by underlying physical abnormalities. These individuals will need to have all or part of their epididymis surgically removed (while the testicle remains in place) in a procedure called an epididymectomy. Since surgery may have complications, medical treatments are often prescribed first.⁵

Prevention

The most effective method in preventing symptoms and complications of epididymitis is to get an early diagnosis and subsequent treatment. Practicing safe sex is a great way to prevent epididymitis caused by STIs. If you are sexually active, the only way to truly know if you have contracted any STIs is to contact your healthcare provider and get tested!⁴

References

1. "Epididymitis – Topic Overview." WebMD. Healthwise, Incorporated, 14 Nov. 2014. Web. 1 Mar. 2016.
2. "Epididymitis." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 28 Jan. 2011. Web. 1 Mar. 2016.
3. "Epididymitis and Orchitis." Urology Care Foundation. American Urological Association, n.d. Web. 01 Mar. 2016.
4. "Epididymitis." MedlinePlus. U.S. National Library of Medicine, 29 Sept. 2014. Web. 01 Mar. 2016.
5. "Epididymitis." Mayo Clinic. Mayo Foundation for Medical Education and Research, 7 May 2015. Web. 01 Mar. 2016.
6. "Preparing for Your Appointment." Mayo Clinic. Mayo Foundation for Medical Education and Research, 09 Apr. 2013. Web. 04 Feb. 2016.
7. "Questions to Ask Your Doctor." Certification Matters. American Board of Medical Specialties, n.d. Web. 04 Feb. 2016.

Last Updated 09 March 2016.