Epididymitis is inflammation of the epididymis, which is a tube located at the back of the testicles. The tube stores and carries sperm.
Epididymitis is most common in men aged 19 to 35 and is a frequent cause of military hospitalizations.
Epididymitis is caused by an infection, usually a bacterial or a sexually transmitted infection. The condition usually improves with antibiotics.
Epididymitis can be caused by a nonsexual infection, such as urinary tract infections (UTIs) and prostate infections. However, the most common cause of epididymitis are sexually transmitted infections (STIs)—specifically gonorrhea and chlamydia.
Risk factors include:
- having unprotected sex
- structural problems in the urinary tract
- recent urinary tract surgery
- using a urinary catheter
- enlarged prostate causing blockage in the bladder
- use of the heart medication amiodarone
- being uncircumcised
- heavy lifting or straining
- tuberculosis (TB)
Epididymitis may begin with only a few symptoms. Left untreated, the symptoms tend to worsen.
- low-grade fever
- pain in the pelvic area
- pressure in the testicles
- painful and swollen scrotum
- red and warm scrotum
- pain and tenderness in the testicles
- enlarged lymph nodes in the groin
- pain with urination or bowel movements
- urgent and frequent urination
- pain with intercourse and ejaculation
- blood in the semen
If you are experiencing symptoms of epididymitis, your doctor will first complete a physical examination. He or she will look for testicular swelling, swelling of the lymph nodes in the groin area, and discharge from the penis. If there is discharge, your doctor will use a swab to collect a sample and test for STIs.
If your doctor suspects epididymitis caused by an enlarged prostate, he or she will conduct a rectal examination. He or she may also order blood tests. A complete blood count (CBC) will tell your doctor if there is an infection in your system.
Your doctor may ask for a urine sample. Urinalysis (urine test) results can indicate urinary tract infections and STIs.
Imaging tests can rule out other conditions, such as testicular torsion (a twisted spermatic cord). Your doctor may use an ultrasound, which uses sound waves to create an image of the structures in the body. With this test, your doctor will be able to see testicular torsion and any testicular tumors.
If your doctor orders a testicular scan, which is a nuclear type of scan, you will be asked to drink a small amount of a radioactive substance. Your doctor will scan your body using cameras that detect the radioactive substance. This gives your doctor information about the blood flow in your testicles, which can help diagnose testicular torsion or epididymitis.
Treatment involves treating the underlying infection, as well as easing symptoms. Common treatments include:
- pain medication
- anti-inflammatory medication
- cold therapy (applying cold packs to the scrotum)
- elevating the scrotum
- wearing an athletic cup for support
- abstaining from sexual intercourse
It is important that you take your entire course of antibiotics to treat the infection. You should see your doctor after you have finished the medication to make sure that the infection has cleared.
Usually, these treatment methods are successful. However, there are some cases where more invasive treatment is needed.
If an abscess (pocket of pus) has formed, your doctor can drain the abscess using a needle.
Surgery is an option if no other treatments have been successful. This involves removing all or part of the epididymis. Surgical treatment may also be necessary to correct any physical defects that may be causing the epididymitis.
Most cases of epididymitis are successfully treated using antibiotics. However, there are possible complications if the infection goes untreated. These complications are rare but may include:
- chronic epididymitis
- atrophy (shrinkage) of the testicles
- fistula (abnormal passageway) in the scrotum
- testicular infraction (death of testicular tissue)