Epididymitis is an infection of the epididymis. The epididymis is a soft, coiled tubular structure on the back of the testicle.
What is going on in the body?
Infections generally spread to the epididymis from the bladder or the urethra. The urethra is the tube that allows urine to pass from the bladder to the outside of the body.
In young children or older men, bacteria that cause urinary tract infections (UTIs) are often the cause. Sexually transmitted infections are more likely to be the cause in sexually active young men.
Infection in the epididymis causes severe pain and swelling. The infection may spread to the testicle. When both structures are inflamed, the condition is known as epididymo-orchitis.
It is rare that an infection will occur in the testicle alone. The bacteria will usually infect the epididymis first.
What are the causes and risks of the disease?
Risk factors for epididymitis are the same as for infections of the urethra or bladder. These two conditions create an increased risk for epididymitis.
Infections of the urethra are often sexually transmitted. These infections may be avoided by not having sex or by having sex with one person for life. Condoms may provide some protection.
Bladder infections are more common in those with inherited kidney and bladder problems. Bladder infections are also more common in those with enlarged prostate glands.
Persons who need to use urinary catheters are at a higher risk for epididymitis. Urinary catheters are urine drainage tubes placed through the penis into the bladder.
What can be done to prevent the disease?
Avoidance of the risk factors mentioned above can reduce the risk of epididymitis. When early treatment is given for infection of the bladder or urethra, epididymitis can often be avoided. Symptoms of these two conditions may include frequent and painful urination. A burning sensation in the penis during urination, unusually strong urges to urinate and fever can also occur. If these symptoms occur, affected persons are advised to see a healthcare provider. Unfortunately, infections of the urethra and bladder sometimes cause no symptoms. Epididymitis is difficult to prevent in these cases.
How is the disease diagnosed?
A physical exam and medical history are the keys to diagnosis. Pain comes on rapidly over a 1 or 2 day period. Symptoms of bladder infection may also be present. Urine tests such as urinalysis or urine culture may be done to look for signs of infection.
Epididymitis can sometimes be confused with testicular torsion. Torsion is a painful condition that occurs when a testicle twists abnormally and cuts off its own blood supply. Torsion is rare in older men. However, in a younger, sexually active man the two problems may look similar. Scrotal ultrasonography, a special x-ray test, may be needed to tell the difference.
Long Term Effects
What are the long-term effects of the disease?
Untreated, this disease can destroy the epididymitis or the testicle. An abscess, or pocket of pus, can also form in the scrotum. The infection could even spread throughout the body and be life threatening. Even after successful treatment, there is a risk of chronic epididymitis and chronic pain.
What are the risks to others?
Epididymitis itself is not generally contagious. However, those with epididymitis may have a sexually transmitted disease that is contagious.
What are the treatments for the disease?
Epididymitis is generally treated with 10 to 14 day of antibiotics such as:
doxycycline (i.e., Adoxa, Doryx, Oracea, Periostat, Vibramycin) and an injection of ceftriaxone (i.e., Rocephin)
ciprofloxacin (i.e., Cipro)
levofloxacin (i.e., Levaquin)
- norfloxacin (i.e., Noroxin)
NSAIDs such as ibuprofen (i.e., Advil, Motrin) and naproxen (i.e., Aleve, Naprosyn) or acetaminophen (i.e., Tylenol) can be used for discomfort.
Hospitalization and intravenous antibiotics may be needed for severe infections.
It is important to treat an affected person's sexual partners after a sexually transmitted disease. This prevents a repeat infection.
If examination and x-ray tests cannot rule out testicular torsion, surgery may be necessary. Untreated testicular torsion may lead to destruction of the affected testicle.
What are the side effects of the treatments?
Medications used to treat this problem may cause:
- allergic reaction
- stomach upset
- skin sensitivity to sunlight
If surgery is required, there is a risk of bleeding and infection, as with all surgeries.
What happens after treatment for the disease?
A person may have a relapse if the course of medication is not long enough. In these cases, 6 weeks of medication may be needed. Sometimes, persons will need another 8 to 12 weeks of antibiotics after that.
How is the disease monitored?
Even if treated adequately, epididymitis can recur. Surgery to remove the epididymitis or the testicle may be needed if:
- an episode does not respond to antibiotics
- an abscess or pocket of pus develops