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Epididymitis at a glance

  • Epididymitis is a bacterial infection in the epididymis, a thin tube located in the back of the testicle that stores and transports semen.
  • Men with epididymitis may experience painful urination or intercourse, as well as blood in the urine or semen.
  • Causes of epididymitis include bacterial buildup (E. coli for example) in the urethra that travels to the testicles and sexually transmitted infections (STIs) such as gonorrhea and chlamydia.
  • Acute epididymitis is curable and typically treated with antibiotics, while treatment for chronic versions attempts to reduce overall discomfort during outbreaks.

What is epididymitis?

Epididymitis is a common inflammatory condition of the epididymis, a coiled tube located in the back portion of the testicle. The epididymis is responsible for transporting and storing maturing sperm.

Men can have either acute or chronic versions of epididymitis. Acute epididymitis is signaled by sudden and severe symptoms. A case of epididymitis that persists for more than six weeks is considered chronic. Acute epididymitis may turn chronic when the specific cause of the infection is unknown and consequently left untreated. Chronic epididymitis, unlike acute, is not completely curable, but can be managed symptomatically.

If left untreated, epididymitis may cause an abscess, also known as a puss pocket, on the scrotum or even destroy the epididymis, which can lead to infertility. As with any infection left untreated, epididymitis may spread into another body system and, in rare cases, even cause death.

Causes of epididymitis

Sexually transmitted bacterial infections, such as gonorrhea or chlamydia, are the most common causes of epididymitis in sexually active men. Sometimes an inflamed testicle (known as epididymo-orchiti) that is not the result of an STI may cause epididymitis. The medication amiodarone has been linked to increased scrotal inflammation, which can result in epididymitis.

In young, non-sexually active boys, epididymitis may be caused by urinary tract infections or a bladder or kidney infection that finds its way to the testicles and results in epididymitis. Any injury or trauma to the groin area may also cause epididymitis. In rare cases, the root cause of epididymitis is unidentifiable.

Symptoms of epididymitis

Men who experience pain in their testicles or scrotum may have epididymitis and should visit a urologist as soon as possible to rule out other conditions, such as testicular torsion.

Other symptoms of epididymitis may include:

  • Asymmetrical testicular pain or tenderness
  • Painful and frequent urination
  • Swollen, warm or red colored scrotum
  • Uncomfortable intercourse
  • Blood in the semen.

Typically in chronic epididymitis, the pain occurs mostly in the scrotum and is less severe than the acute version.

Treating epididymitis

Treating epididymitis as soon as it is discovered is imperative, as it will not clear up on its own. Standard treatment for acute epididymitis includes a two-week dose of antibiotics. Scrotum tenderness may take a few weeks after taking medication to completely vanish. In patients with chronic epididymitis, pain medication is typically used to treat the symptoms.

Surgery for epididymitis

In rare cases, an abscess may form on the scrotum that requires surgical removal. During surgery all or part of the epididymis may need to be removed, which is also referred to as an epididymectomy. Surgery may be considered if the patient’s epididymitis is due to underlying physical malformation.