Epididymitis: overview and more

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Epididymitis is an inflammation of the epididymis, the coiled tube at the back of the testicle that stores and carries sperm. Epididymitis is characterized by pain, redness, and swelling, usually in a single testicle. Bacterial infections are the predominant cause of epididymitis, especially sexually transmitted infections such as chlamydia and gonorrhea .

Epididymitis is diagnosed by analyzing symptoms and blood and bacterial culture tests to determine the underlying cause. Bacterial antibiotics are the mainstay of treatment.

Getty Images / Ariel Skelly

What is epididymitis?

Epididymitis is an inflammatory condition that is commonly associated with sexually transmitted infections, although there may be other causes. The condition is divided into two subgroups: acute and chronic.

Acute epididymitis is characterized by the rapid onset of symptoms and, by definition, does not last more than six weeks. It is almost always associated with some form of infection, often sexually transmitted.

On the other hand, chronic epididymitis is an epididymitis that persists for more than 12 weeks. This form is less common and is usually associated with a past injury, surgery, or infection that has damaged the epididymis in some way.

The duration of symptoms and their severity are important factors in deciding treatment.

Symptoms

Symptoms of epididymitis can vary depending on whether the condition is acute or chronic. Generally speaking, the pain of acute epididymitis tends to be sharp, whereas chronic epididymitis causes a dull or throbbing pain.

Common symptoms

Men with acute and chronic epididymitis may experience some or all of the following signs and symptoms:

  • Testicular pain and pressure (usually in one)
  • Redness, warmth, and swelling of the scrotum.
  • Pain when urinating
  • The need to urinate frequently.
  • Pain during intercourse or ejaculation.
  • Blood in semen

Acute epididymitis

Acute epididymitis tends to develop over several days, with pain, redness, swelling, and warmth generally confined to one testicle. The scrotum of the affected testicle often hangs lower.

The epididymis itself will be significantly thicker and dense. There may be visible discharge from the opening of the penis (urethra) and pain or burning when urinating.

Distinctive features of epididymitis.

Fever, chills, discharge from the penis, and swollen lymph nodes in the groin are signs of a urinary tract infection.

Chronic epididymitis

Chronic epididymitis can present with persistent pain and discomfort, although the actual edema of the epididymis can come and go. The pain often spreads to the groin, thigh, and lower back. Sitting for a long time can make the situation worse .

The persistent inflammation associated with chronic epididymitis can spread to the prostate, causing discomfort in the groin and perineum (the area between the scrotum and the anus) and difficulty urinating.

Complications

If left untreated, acute epididymitis can lead to serious complications, including the development of testicular abscesses and necrosis (tissue death). Chronic epididymitis can cause irreversible obstruction of the epididymis, leading to decreased fertility and hypogonadism (low testosterone levels) .

In some cases, the underlying infection can spread to other organs. Men with benign prostatic hyperplasia (an enlarged prostate) may experience a worsening of symptoms as a result of inflammation of the epididymis.

Causes

Epididymitis is not a disease, but a consequence of a disease. Although epididymitis is commonly associated with bacterial infections, there are non-infectious causes that can affect both men and boys. Boys and men between the ages of 14 and 35 are most often affected .

Infectious causes

Although urinary tract infections (UTIs) are rare in men, bacterial infections are the most common cause of acute epididymitis. These include :

  • Sexually transmitted bacterial infections such as chlamydia ( Chlamydia trachomatis ) and gonorrhea ( Neisseria gonorrhoeae )
  • Escherichia coli ( E. coli ), a bacteria that can enter the urethra through fecal contamination or anal sex.
  • Complications of tuberculosis (TB)
  • Viral infections such as enterovirus, adenovirus, and influenza in young children .
  • Opportunistic infections such as ureaplasma, mycobacteria, cytomegalovirus, or cryptococci in men with HIV.

Unprotected sex and risk of epididymis

Men who have unprotected sex and / or circumcision generally have a higher risk of epididymitis .

Some men with chronic epididymitis have previously had an acute infection that damaged the epididymis. In some cases, trauma can affect the blood vessels or nerves that serve the epididymis, making it vulnerable to bouts of inflammation during illness, extreme physical activity, or other potential triggers.

Non-infectious causes

There are also non-infectious causes of epididymitis. This includes:

  • Benign prostate hypertrophy (enlarged prostate)
  • Genitourinary surgery (including vasectomy )
  • Urinary reflux (urine reflux)
  • Urinary catheters
  • Corados (amiodarone ), a drug used to treat heart rhythm disorders, is also available as paseron.
  • Sarcoidosis , a disease characterized by hard granulomas.
  • Behcet's disease, an autoimmune disease that often causes epididymitis, occurs in black men.

In young boys, direct trauma and testicular torsion (abnormal twisting of the testicle and epididymis) are the most common causes of epididymitis. The same can happen in adult men, often during sports or extreme physical activity.

Diagnostics

Epididymitis can be diagnosed by looking at symptoms and medical history. The physical exam will look for signs of redness, swelling, tenderness, and warmth that occur on one side (only on one side) .

The doctor can also look for signs of discharge, which are often found by gently milking the penis with gloved hands. If chlamydia or gonorrhea is suspected, the doctor will take a swab of the discharge and send it to a laboratory for evaluation. Blood and urine tests may be done to look for other causes.

If the cause of the epididymitis is not clear or the symptoms are unusual, the doctor may order a Doppler ultrasound to visualize the epididymis and assess blood flow in the affected area.

Differential diagnosis

Conditions that mimic epididymitis include inguinal hernia , infected hydrocele, and testicular cancer , so a doctor can rule out these and other possible causes to be sure of the most effective diagnosis and treatment.

To distinguish epididymitis from testicular torsion, doctors can check the cremasteric reflex (in which the testicle is lifted by stroking the inner thigh). A positive cremasteric reflex usually rules out testicular torsion as the cause. There will also be a positive foam sign, in which pain persists even when the scrotum is lifted.

Doppler ultrasound is the most effective way to distinguish epididymitis from inguinal hernia, hydrocele, and testicular cancer.

Watch out

In 2021, the US Centers for Disease Control and Prevention published guidelines for the treatment of sexually transmitted infections, including epididymitis. Prompt treatment of epididymitis is necessary to correct the underlying infection, prevent testicular damage, and prevent the transmission of sexually transmitted diseases.

The recommended treatment for acute epididymitis depends on the probable cause and whether the patient is an injection partner:

  • Chlamydia or gonorrhea: Ceftriaxone 500 mg once more doxycycline 100 mg orally 2 times a day for 10 days.
  • Chlamydia, gonorrhea or intestinal microorganisms (men who practice anal insertion): ceftriaxone 500 mg single dose plus levofloxacin 500 mg.
  • Intestinal microorganisms only: levofloxacin 500 mg orally once a day for 10 days.

If you are prescribed an antibiotic for acute epididymitis, you will feel relief within 48 to 72 hours. Chronic epididymitis may take longer to resolve.

Don't cut back on antibiotics

It is very important to complete the full course of antibiotic treatment, even if the symptoms have disappeared. If antibiotics are stopped too early, there is a risk of antibiotic resistance, making it difficult to treat a recurrent bacterial infection.

Front facing

Whether you have acute or chronic epididymitis, there are a few simple things you can do to ease the discomfort of pain:

  • Relax by lifting your feet to relieve pressure on the scrotum.
  • Wear loose-fitting, loose-fitting underwear, pants, or shorts.
  • Use a sports support to support your scrotum.
  • Avoid lifting heavy objects.
  • Take lukewarm baths to increase blood flow to the scrotum, which will reduce discomfort and aid healing.
  • Put ice packs to reduce acute swelling, use a towel, and use frosting for no more than 15 minutes to avoid freezing.
  • Take an over-the-counter pain reliever such as Tylenol (acetaminophen) or a non-steroidal anti -inflammatory drug such as Advil (ibuprofen) or Aleve (naproxen).

Get the word of drug information

If you develop epididymitis as a result of a sexually transmitted infection, such as gonorrhea or chlamydia, it is important that you tell your sexual partners so they can seek treatment. If you have had sexual intercourse within 60 days after symptoms started, it is likely that you have passed the infection on to other people. To avoid further transmission, avoid sexual intercourse until the infection has been confirmed to be cured.

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