What is Epididymitis?
Epididymitis is inflammation of the epididymis, a long, coiled tube located at the back of the testicle. The epididymis plays a crucial role in the male reproductive system by storing and carrying sperm from the testicles to the vas deferene.
What are the Causes?
Epididymitis is primarily caused by bacterial infections, with the specific causes varying based on age and risk factors:
Sexually Transmitted Infections (STIs)
- Most common in men under 35 years old
- Primarily caused by Chlamydia trachomatis and Neisseria gonorrhoeae
Urinary Tract Infections (UTIs)
- It is more common in men over 35 years old
- Often caused by Escherichia coli and other coliform bacteria
Other Bacterial Causes
- Enteric pathogens like E. coli and Proteus species, especially in men who have insertive anal sex
- Ureaplasma (less common)
- Viral Infections
- Mumps virus
Non-infectious Causes
- Trauma or repetitive activities, particularly in younger males
- Chemical irritation from the retrograde flow of urine
- Medication side effects, particularly amiodarone
Rare Causes
- Tuberculosis
- Brucellosis
- Candida species
- Cryptococcosis
- Behçet's syndrome
Risk factors for developing epididymitis include having an enlarged prostate gland, using urinary catheters, recent groin or urological surgery, and engaging in unprotected sexual activity.
What are the Symptoms?
The main symptoms of epididymitis include:
- Pain and tenderness in the affected testicle, often starting gradually
- Swelling, warmth, and redness of the scrotum
- Low-grade fever and chills
- Discomfort or pain in the lower abdomen or pelvic area
- Pain or burning during urination
- Frequent or urgent need to urinate
- Discharge from the penis
- Pain during ejaculation
- Blood in the semen
- Enlarged lymph nodes in the groin
In some cases, additional symptoms may include:
- Feeling of heaviness in the testicle area
- There is a lump near the testicle
- Testicle pain that worsens during bowel movements
It's important to note that symptoms can vary in severity and may develop suddenly or gradually. Chronic epididymitis, lasting more than 6 weeks, may have similar but persistent symptoms.
If you experience sudden, severe testicle pain, seek immediate medical attention, as this could indicate a more serious condition like testicular torsion.
How is it Treated?
The treatment of epididymitis primarily involves antibiotics and supportive measures to alleviate symptoms. The specific approach depends on the suspected cause and severity of the condition.
Antibiotic Treatment
- For epididymitis likely caused by sexually transmitted infections:
- Ceftriaxone 500 mg IM in a single dose, plus
- Doxycycline 100 mg orally twice daily for 10-14 days
- For epididymitis likely caused by enteric organisms:
- Levofloxacin 500 mg orally once daily for 10 days
- For severe cases or poor response to initial treatment:
- Treatment may be extended up to 3 weeks
Supportive Measures
To manage symptoms and promote recovery:
- Rest and scrotal elevation
- Cold packs or ice applied to the affected area
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief
- Supportive underwear to elevate the testicles
- Increased fluid intake
Additional Considerations
- Patients should start feeling better within 48-72 hours of appropriate treatment.
- Complete resolution may take several weeks.
- Sexual activity should be avoided until treatment is complete and symptoms have resolved.
- Partners from the past 6 months should be notified and tested if an STI is suspected.
In rare, severe cases where conservative treatments fail, surgical intervention such as epididymectomy or orchiectomy may be considered.
Dr Clem Bonney & Epididymitis
Dr Bonney will assist in the diagnosis and treatment of Epididymitis via appropriate imaging and pathology. Dr Clem Bonney will provide empathetic care for this uncomfortable condition.