Diseases & Conditions

Epididymitis

Epididymitis is an inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm. Pain and swelling are the most common signs and symptoms. Males of any age can get epididymitis, but it's most common in men between the ages of 19 and 35.

Epididymitis is most often caused by a bacterial infection or by a sexually transmitted disease (STD) such as gonorrhea or chlamydia. In some cases, the testicle may also become inflamed — a condition called orchitis.

The signs and symptoms of epididymitis depend on the cause. They can include:

• A tender, swollen, red or warm scrotum
• Testicle pain and tenderness, usually on one side — the pain may get worse when you have a bowel movement
• Painful urination or an urgent or frequent need to urinate
• Painful intercourse or ejaculation
• Chills and a fever that can last up to six weeks
• A lump on the testicle
• Enlarged lymph nodes in the groin (inguinal nodes)
• Pain or discomfort in the lower abdomen or pelvic area
• Discharge from the penis
• Blood in the semen

Chronic epididymitis
Signs and symptoms of epididymitis usually develop over a day or two and get better with treatment. In some cases, epididymitis may not clear up completely, or may recur. This is known as chronic epididymitis. Symptoms of chronic epididymitis may come on gradually. Sometimes the cause of chronic epididymitis is not identified.

Never ignore scrotal pain or swelling. A number of conditions can cause testicular pain, and some of the conditions require immediate treatment. Some conditions that cause scrotal pain or swelling can get worse or cause permanent damage if not treated promptly. See a doctor if you have discharge from your penis or pain when you urinate. Testicular torsion, caused by a twisted spermatic cord, can cause pain similar to that caused by epididymitis and requires emergency treatment because it blocks blood flow to the testicle.

Epididymitis may eventually cause:

• Scrotal abscess, when infected tissue fills with pus
• Chronic epididymitis, which can occur when untreated acute epididymitis leads to recurrent episodes
• Shrinkage of the affected testicle (atrophy)
• Impaired fertility, but this is rare

If the condition spreads from your epididymis to your testicle, the resulting condition is known as epididymo-orchitis. Signs, symptoms and treatment options are basically the same as they are for epididymitis.

Epididymitis caused by a sexually transmitted disease (STD) or other infection is treated with antibiotic medications. Your sexual partner will also need treatment. Make sure your doctor is aware of any other medications you're taking or any allergies you have. This information, as well as determining what type of infection you have, will help your doctor select the best treatment.

Be sure to take the entire course of antibiotics prescribed by your doctor, even though you may get relief from your symptoms in two to three days after you start treatment. If you're not feeling better in that time, contact your doctor. When you've finished your medication, it's a good idea to return to your doctor for a follow-up visit to be sure that the infection has cleared up.

In most cases, symptoms improve after a few days of antibiotics. If your symptoms don't improve as expected, your doctor may try another antibiotic. If symptoms still don't improve, your doctor may do further tests to determine whether your epididymitis is caused by something other than a bacterial infection or STD.

If a pocket of pus (abscess) has formed, it may need to be drained, and in some cases part or all of the epididymis needs to be removed surgically. Surgery is sometimes necessary if epididymitis is due to underlying physical defects or if epididymitis is caused by tuberculosis.