Definition

Acute epididymitis is an inflammation of the epididymis. This is a structure that surrounds and attaches to each testicle. It is shaped like a tube. The epididymis helps transport and store sperm cells.

Chronic epididymitis causes discomfort or pain in the epididymis. It can last for 3 months or longer. This type is less common.

Causes

This condition is most often caused by a bacterial infection. For example:

• Urinary tract infection
• Sexually transmitted diseases (STDs), such as chlamydia and gonorrhea
• Infection of the urethra—urethritis
• Infection of the prostate—prostatitis
• Tuberculosis

Other causes include:

• Injury
• Viral infections, such as mumps
• Genital abnormalities
• Treatment with amiodarone, a heart rhythm drug
• Chemotherapy to treat bladder cancer
• Vasectomy

Risk Factors

Only men can develop this condition. It affects men age 15-30 with sexually transmitted bacteria begin a common cause. It also affects men over 60 with urinary tract infections being a common cause.

Other factors that increase the risk of epididymitis include:

• Infection of the genitourinary tract—urethra, bladder, kidney, prostate, or testicle
• Narrowing of the urethra
• Use of a urethral catheter
• Infrequent emptying of the bladder
• Recent surgery or instrumentation of the genitourinary tract—especially prostate removal
• Birth defects of the genitourinary tract
• Unprotected sex
• Disease that affects the immune system

Children and newborns can get epididymitis.

Symptoms

Symptoms usually develop within 1 day. These include:

• Pain in the testicles
• Sudden redness or swelling of the scrotum
• Hardness, a lump, and/or soreness in the affected testicle
• Tenderness in the unaffected testicle
• Groin pain
• Chills
• Fever
• Inflammation of the urethra
• Pain during intercourse or ejaculation
• Pain and/or burning during urination
• Increased pain while having a bowel movement
• Lower abdominal discomfort
• Discharge from the penis

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

Your bodily fluids may be tested. This can be done with:

• Urinalysis
• Urine culture
• Culture or other test of discharge from penis
• Blood tests

Images may be taken of your scrotum. This can be done with ultrasound.

Treatment

Treatment is essential to prevent the infection from worsening. Treatment may include:

• Bed rest—This keeps the testicles from moving and promotes healing. You may need bed rest until the swelling goes away.
• Antibiotics—You will be given antibiotics to treat a bacterial infection. Many cases of epididymitis are caused by sexually transmitted bacteria. Chlamydia is one of the most common. If you have an STD, your partner(s) will also need treatment.
• Oral anti-inflammatory medication—This includes drugs like ibuprofen to help reduce swelling.
• Scrotal elevation and support—You may need to wear an athletic supporter for several weeks.
• Warm baths—Taking baths can ease the pain and help relieve swelling.
• Surgery—This may be needed in severe cases that keep coming back.

Prevention

The following steps can help decrease your risk:

• Practice safe sex. Protect yourself from STDs by using condoms.
• Empty your bladder as soon as you feel the need.

Urology Care Foundation http://www.urologyhealth.org

The Kidney Foundation of Canada http://www.kidney.ca

Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guide: 2006. MMWR. 2006;55. Centers for Disease Control and Prevention website. Available at:
http://www.cdc.gov/std/treatment/2006/rr5511.pdf
Accessed August 31, 2015.

Hori S, Sengupta A, et al. Long-term outcome of epididymectomy for the management of chronic epididymal pain. J Urol. 2009 Oct;182(4):1407-1412.

Santillanes G, Gausche-Hill M, et al. Are antibiotics necessary for pediatric epididymitis? Pediatr Emerg Care. 2011 Feb 19.