The Facts About Epididymitis

Epididymitis is an inflammation of the epididymis, a coiled tube at the back of the testicle that stores and carries sperm. Whenever the epididymis becomes swollen, it can cause intense pain in the testicle. While males of all ages can get epididymitis, it's most common in males between the ages of 14 and 35. An estimated 600,000 Americans suffer from epididymitis each year.

Epididymitis is typically caused by a bacterial infection, including such sexually transmitted infections (STIs) as chlamydia and gonorrhea. Acute epididymitis is felt quickly with pain and redness, usually involving inflamed testes. Acute epididymitis goes away with treatment, but lasts for about six weeks and worsens over time if left untreated.

Chronic epididymitis typically involves duller pain, develops slowly and lasts six weeks or longer. Symptoms include pain in the scrotum, epididymis or the testes. Chronic epididymitis can improve but may not fully go away with treatment. It can come and go.

Epididymitis often develops as a result of an infection in the bladder or urethra (the tube that carries urine and semen) that moves to the epididymis. In children, mumps and other viruses may cause epididymitis. Additionally, the heart medication amiodarone has been associated with epididymitis.

Epididymitis can be caused by a number of factors. Some unusual causes include tuberculosis, mumps, Behcet's disease (a rare disorder that causes blood vessels to become inflamed), and kidney and bladder problems.

But two main types of infection cause epididymitis: STIs and urinary tract infections (UTIs). Epididymitis caused by an STI is most common in young men, age 35 or less, especially those who have unprotected sex with multiple partners and have sex with men. Epididymitis that is not caused by an STI is not as common.

Men older than 35 (who don't report having insertive anal intercourse) are less prone to STI-caused epididymitis. For older men, the CDC says "nonsexually transmitted acute epididymitis is also associated with prostate biopsy, urinary tract instrumentation or surgery, systemic disease, and/or immunosuppression." Epididymitis caused by a UTI typically occurs in men older than 65. A UTI in men is more common if you have an enlarged prostate pressing on the bladder, a recent groin, bladder or prostate surgery, or a urinary catheter. Inflammation will typically happen due to an injury to the area, urine flowing back into the epididymis or twisting of the epididymis.

You might be at a greater risk for developing epididymitis if you:

• Have an uncircumcised penis
• Have a history of infections in the prostate or urinary tract
• Have an enlarged prostate
• Have unprotected sex
• Have a history of STIs
• Have a partner with an STI
• Have tuberculosis
• Had urinary tract surgery recently
• Have insertive anal sex regularly
• Use a urinary catheter
• Use the heart medication amiodarone
• Experienced a groin injury recently

Prevention is not wholly possible with epididymitis, but there are ways to reduce your risk by getting vaccinated for mumps, practicing safer sex, limiting your number of sexual partners and getting regularly screened for sexually transmitted infections.

If you've had epididymitis and are hoping to prevent a recurrence, discuss a plan with your doctor.

When a bacterial infection occurs, the epididymis becomes swollen and painful over time. This will cause pain in one or both of the testicles. The affected area will likely become swollen, red and warm to the touch.

You may experience the following symptoms:

• Painful urination or frequent need to urinate
• Pressure in the testicles
• Discharge from the urethra
• Abdominal pain
• Groin swelling and pain
• Pain during sex
• Blood in the urine and semen
• Pain associated with ejaculation
• Testicle lump
• Fever
• Chills
• Nausea

The symptoms will typically depend on the cause of your epididymitis. For instance, if you have discharge from the penis, it is likely to be attributed to an STI. The urge to urinate is probably due to a UTI.

Symptoms can also be similar to those of testicular torsion, a condition in which the testicle rotates, twisting the spermatic cord that carries blood to the scrotum. This condition requires emergency surgery so blood flow can be restored to the testicles.

If you're experiencing any of these symptoms, it's critical that you see a doctor right away to begin treatment.

A doctor can diagnose epididymitis after a careful review of your symptoms and medical history. During the physical exam, they will look for signs of redness, swelling, tenderness and warmth.

A physician might also look for signs of discharge. This can be revealed by gently milking the penis. If chlamydia or gonorrhea is suspected, a swab of the discharge can be sent to a lab for examination. If the cause of epididymitis is unclear, the doctor may make use of a Doppler ultrasound to visualize the epididymis and examine the blood flow to the affected area.

Antibiotics, which kill bacterial infections, are the most common treatment for epididymitis. If your doctor believes you have epididymitis, they may give you a prescription for antibiotics before the lab results are returned. Patients typically take antibiotics for one to two weeks, but be sure to follow the exact instructions. Finishing your round of antibiotics is necessary.

Many people start feeling better in a matter of days after taking the antibiotic. However, some swelling might last for several weeks and you may feel sore during this time.

You can try several steps to alleviate pain from acute or chronic epididymitis, including elevating the scrotum, wearing loose-fitting clothing, wearing a jockstrap to support the scrotum, taking warm baths to increase blood flow, applying a cold compress for swelling (no more than 15 minutes at a time) and using over-the-counter pain relievers. You should avoid lifting heavy objects during your treatment.

If your epididymitis was caused by an STI, it's prudent to abstain from sexual activity until the infection has cleared. You should inform your sexual partner(s) of the infection so they can get examined as well.

The majority of acute epididymitis cases are successfully treated using antibiotics. Long-term sexual or reproductive problems are rare but not impossible. Potential complications include chronic epididymitis, infertility caused by permanent damage to the epididymis, an abscess or the spread of the infection to other parts of the body.

While most cases of epididymitis are resolved easily, it's critical to seek medical attention right away to prevent complications. Once you receive treatment, make sure you take the entire course of antibiotics, even if you feel better. See your doctor after you have completed the antibiotics course to ensure that the infection has cleared.

If you are suffering from ongoing pain, schedule an appointment to see your doctor, particularly if the symptoms do not improve within several days. If you have severe pain in the scrotum or testes or you are running a fever, seek medical care immediately.