What is epididymitis?
Acute epididymitis is a medical condition that occurs when the epididymis, a small, coiled tube located at the back of the testicles, becomes inflamed. The epididymis is part of the male reproductive system. It stores and carries sperm.
This inflammation can cause pain, swelling, tenderness in the scrotum, fever, and malaise. Epididymitis is more commonly seen in young men between the ages of 19 to 35 but can occur in men of any age.
It is often caused by a bacterial infection that can be acquired through sexual contact or by a urinary tract infection. Other possible causes include viral infections, trauma to the scrotum, and certain medications. While epididymitis can be a painful and uncomfortable condition, prompt diagnosis and treatment can usually help to alleviate symptoms and prevent complications.
Is acute epididymitis caused only by sexually transmitted infections (STIs)?
No. STI is one of the causes of epididymitis and orchitis, typically occurring in younger males.
How did my husband, boyfriend, or partner get epididymitis?
Various risk factors may contribute to the development of epididymitis, and it can be challenging to pinpoint the exact cause without a thorough medical history and evaluation.
It's possible that your husband may have contracted a bacterial infection through sexual activity or developed an infection in the urinary tract that spread to the epididymis.
However, epididymitis can be caused by an infection or other nonsexually transmitted infections, such as not emptying the bladder well, trauma, medical conditions that weaken the immune system or medication use.
If you have any concerns or questions about your husband's condition, it's recommended that you seek guidance from a healthcare provider, who can provide you with advice and further evaluation.
If my husband or boyfriend has epididymitis, can I get it?
A partner can contract the bacteria that causes epididymitis through sexual intercourse if the underlying infection is due to a sexually transmitted infection (STI). One needs to remember that there are other causes leading to epididymitis.
Suppose your partner has been diagnosed with epididymitis, and there is a strong suspicion that it is from an STI. In that case, it's recommended that you both get tested for STIs and follow safe sexual intercourse practices until the infection has been treated and resolved.
What causes acute epididymitis?
Bacterial infection: This is the most common cause of epididymitis, often resulting from the spread of bacteria from the urethra or bladder into the epididymis. Sexually transmitted infections (STI), such as gonorrhoea and chlamydia, can also cause epididymitis. Other bacterial infections that can cause epididymitis include E. coli and Staphylococcus.
Viral infection: Viral infections such as mumps virus, a common childhood illness, can sometimes lead to epididymitis. In rare cases, other viral infections such as HIV, herpes, and cytomegalovirus (CMV) may also cause epididymitis.
Urinary tract infection (UTI): A UTI can sometimes spread to the epididymis and cause epididymitis. This is common in men who are not emptying their bladder well.
Interventions: Prostate biopsy, urinary catheter insertion and other urological procedures can cause epididymitis.
Structural problems: some males have a narrowing in the water pipe (urethra) that leads to issues in emptying the bladder. Stagnant urine gets infected. Since the male genitourinary tract means that bother the urinary part and the genital part are connected, the infection spreads from the urinary tract to the genital. This can lead to epididymitis.
Trauma to the scrotum or groin injury: Injuries to the scrotum, such as sports injuries or car accidents, can cause inflammation in the epididymis.
Certain medications: Some medications, such as amiodarone, used to treat irregular heart rhythms, can cause inflammation in the epididymis.
Tuberculous epididymitis: Mycobacterium tuberculosis is the cause of this. These are very rare cases of epididymitis. The classical sign is that the spermatic cord feels like beads.
What are the symptoms of inflammation of the epididymis?
- Pain and discomfort: testicle or scrotal pain, ranging from mild to severe. Testicular pain has a gradual onset and worsens over time, but some males experience a sudden onset of pain.
- Swelling: The epididymis can become swollen and tender, and the scrotum may appear red or inflamed.
- Painful urination: Epididymitis can cause pain or discomfort when urinating, which may feel like a burning sensation.
- Painful ejaculation: In some cases, epididymitis can cause pain or discomfort during ejaculation.
- Fever: chills and rigours, feeling hot and weak
- Groin pain: may also be felt in the groin area or lower abdomen.
- Blood in semen: Epididymitis can cause blood to appear in the semen, which can be alarming.
- Penile discharge: The discharge may appear white (pus-like) or cloudy. This may or may not be present. Easy morning discharge is the common complaint, indicating a high likelihood of an STI.
- Lymph nodes: can become swollen in severe cases of epididymitis.
Does the testicle infection go away by itself?
Seek treatment immediately. Left untreated, the infection can spread to the testicle, called epididymo orchitis, with a high risk of abscess formation and testicle tissue damage. The infection can spread, making you seriously ill.
In many cases, prompt medical care is necessary to effectively manage acute epididymitis, reduce symptoms, and prevent potential complications. Treatment may include antibiotics, pain management, and rest.
What tests are commonly ordered?
Several tests may be ordered to confirm the diagnosis and identify the underlying cause. These tests may include the following:
- Urine analysis: A urine sample test is often asked to see if there are any bacteria or white blood cells. These can be signs of a urinary tract infection or another condition causing epididymitis.
- Blood tests: Blood tests may be ordered to check for signs of infection, inflammation, or other underlying medical conditions contributing to epididymitis.
- Ultrasound: An ultrasound may be used to evaluate the scrotum and epididymis for signs of inflammation, swelling, or fluid accumulation. It excludes other causes that mimic epididymitis, like testicular cancer.
- Sexually transmitted infection (STI) tests: If the underlying cause of epididymitis is suspected to be an STI, tests for specific infections such as chlamydia or gonorrhoea may be ordered. You will be asked to contact your most recent sex partner or long-term sexual partner to get tested.
What are the treatment options for epididymitis?
In cases caused by bacterial infections, antibiotics are typically prescribed. The antibiotic type and treatment length will vary depending on the severity and duration of the infection and the specific bacteria causing it. The antibiotic regimen can include a combination of antibiotics.
Commonly used antibiotics include doxycycline, azithromycin, ciprofloxacin, and levofloxacin.
In addition to antibiotics, pain relief medications such as ibuprofen may be recommended to relieve discomfort and reduce inflammation.
Elevating the scrotum and applying ice packs may also help reduce swelling and pain.
If one is suffering from lower urinary tract symptoms and not emptying the bladder properly, the prostate gland is examined, and medications are prescribed to help empty the bladder.
In some cases, if the infection is severe or doesn't respond to antibiotics, hospitalisation may be necessary for intravenous antibiotics and pain management.
Surgery may also be required in rare cases when the severe infection has led to an abscess (collection of pus) or complications arise.
Failure to complete the entire course of antibiotics may lead to antibiotic resistance and recurrence of the infection.
How long does epididymitis pain last?
With prompt and appropriate treatment, most cases of acute epididymitis can start to improve within a few days, and pain and swelling may resolve within a week or two.
However, I always tell my patients that, in some cases, the swelling may persist for several weeks or even months.
What can be mistaken for epididymitis?
Several conditions can cause symptoms similar to epididymitis, making diagnosing it challenging. The differential diagnosis includes:
Testicular torsion: This surgical emergency occurs when the testicle twists, causing reduced blood flow to the testicle, leading to testicular infarction. Symptoms can include sudden and severe pain, swelling, and redness, similar to epididymitis or epididymo orchitis.
Testicular cancer can cause swelling or a lump in the testicle, which can be mistaken for epididymitis or epididymo orchitis.
Referred pain: Pain from other body areas, such as the lower back or abdomen, can sometimes be felt in the testicle and may be mistaken for epididymitis. Kidney stones can present this way.
What is chronic epididymitis?
Chronic epididymitis is inflammation of the epididymis, causing pain and discomfort that usually lasts over three months.
Chronic epididymitis affects around 1 per cent of the male population. It is a known cause of chronic pelvic pain syndrome (CPPS).
Chronic epididymitis occurs due to various causes, such as bacterial or sexually transmitted infections, previous injuries to the scrotum, or other medical conditions.
What should I feel if I have chronic epididymitis?
Ongoing scrotum pain, swelling, redness, and a feeling of warmth in the affected area.
Some people may also experience a sensation of heaviness in the scrotum, tenderness, or sensitivity, as well as pain or discomfort during sex, urination, or ejaculation.
What are the treatment options for chronic epididymitis?
Treatment options may involve a combination of medications, such as antibiotics to treat any underlying infections, pain relief to manage discomfort, warm compresses or other self-care measures to reduce swelling and inflammation.
Is there a role in surgical intervention?
Surgery may sometimes be necessary to remove damaged or infected tissue.
