Epididymitis: Causes, symptoms, and treatment

Epididymitis: Causes, symptoms, and treatment

Tom Seymour 
by Alana Biggers, MD, MPH
In the back of the testicles,
there is a coiled tube called the epididymis. This tube stores and carries
sperm and is linked to the ejaculatory duct by another tube called the vas
Epididymitis is when this tube
becomes painful, swollen, and inflamed.
There are two types of
epididymitis. Acute epididymitis comes on suddenly, and pain and inflammation
develop quickly. This kind of epididymitis lasts less than 6 weeks.
Chronic epididymitis develops
slowly and has a duller pain. It is a long-term problem that lasts for longer
than 6 weeks. Males of any age can be affected by the condition.
If the testicles also become
inflamed and painful, then this is known as epididymo-orchitis.
The spread of a bacterial
infection usually causes epididymitis. This infection will often start in the
urethra, prostate, or bladder.
Two main types of infection
cause epididymitis:
Sexually transmitted infection
Epididymitis caused by an STI,
such as gonorrhea or chlamydia, is most common in young, heterosexual men;
particularly those who have sex with multiple partners and do not use a condom.
Cases of epididymitis that are
not caused by an STI are less common.
Urinary tract infection (UTI)
Epididymitis caused by a UTI
occurs in children, older men, and men who have sex with men. The following
factors often cause UTIs in men:

  • enlarged prostate pressing on
    the bladder
  • insertion of a catheter into
    the penis
  • surgery on the groin, bladder,
    or prostate gland

While cases of epididymitis in
children are rare, they do occur. Often the bacterial infection will spread
from the urethra or bladder.
Inflammation will usually
develop due to one of the following:

  • direct injury to the area
  • twisting of the epididymis
  • urine flowing back into the
Other causes

There are also some more
unusual causes of epididymitis:

  • mumps
  • tuberculosis
  • high doses of a medication
    called amiodarone, usually taken for heart rhythm problems
  • groin injury
  • structural problems in the
    urinary tract
  • Behcet’s disease
  • congenital kidney and bladder

Epididymitis will cause pain
in one or both testicles. The affected area will also be red, swollen, and warm
to touch. If it is left untreated, it will worsen over time.
Other symptoms include:

  • fever
  • chills
  • heaviness in the affected
  • enlarged testicle
  • affected testicle sensitive to
  • pain in the abdomen or pelvis
  • frequent urge to urinate
  • burning sensation when
  • discharge from the end of the
  • blood in urine
  • pain when ejaculating or
    having sex
  • fluid buildup around the
    testicle which may feel like a lump
Symptoms will usually depend
on the cause of the epididymitis. For example, discharge from the penis is
likely to be due to an STI, while the urge to urinate probably results from a
Symptoms of epididymitis can
also be similar to those of testicular torsion, a condition that sees the
testicle twist and cut off the blood supply and which requires emergency
surgical treatment.
As a result, if a person
experiences any of these symptoms they should see a doctor straight away.
In children, the most common
symptoms are:

  • discomfort in lower abdomen or
  • a red and tender area on the
    side of the scrotum
  • pain or burning when urinating
  • discharge from the urethra
  • fever

The doctor will probably have
to carry out a physical exam to see if any of the symptoms of epididymitis are
present and to check for signs of infection and inflammation.
It can often be hard to tell
the difference between epididymitis and testicular torsion, particularly in
younger men.
Sometimes epididymitis and
testicular torsion can occur at the same time.
Doctors may perform some other
tests to find the cause. These include:

  • rectal exam, where a doctor
    inserts a finger into the anus to check for an enlarged prostate
  • urine and blood tests
  • urine samples to test for
    gonorrhea and chlamydia
  • ultrasound scans, to identify
    testicular torsion
  • medical history

Treatment will be provided
based on what is causing the epididymitis. If it is a bacterial infection, the
doctor will probably prescribe a course of antibiotics.
If the infection was caused by
an STI, the man must tell their sexual partners. They will also need to abstain
from having sex until the treatment is completed.
As well as this, doctors will
probably also recommend painkillers and anti-inflammatory drugs, such as
ibuprofen, to reduce pain and swelling.
There are also some basic
things that a person can do to reduce discomfort:

  • resting lying down with the
    scrotum elevated
  • applying an ice pack to the
    painful area
  • wearing a scrotal support
In general, once treatment has
started the pain associated with epididymitis will go within 1 to 3 days.
However, some of the symptoms can take months to disappear.
In more severe cases, a person
may have to stay in the hospital and may require some surgical procedures.
Follow-up exams with the
doctor will also be necessary to make sure the infection has cleared up.
Recovery and outlook

In most cases, epididymitis
clears up with antibiotics and bed rest, and there are no long-term sexual or
reproductive problems.
However, the condition can
return, and some complications can occur:

  • abscess in the scrotum, which
    may require draining
  • chronic epididymitis
  • opening on the skin of the
  • the death of testicular tissue
    due to a lack of blood, known as testicular infarction
  • infertility
Chronic epididymitis

In the case of chronic
epididymitis, doctors will not prescribe antibiotics as inflammation occurs
without an infection.
Treatment includes:

  • frequent warm baths
  • anti-inflammatory medication
    that does not contain steroids
  • medication to relax muscles
    and alter nerve messages
  • anesthetic of steroid
    injections into the scrotum
  • surgery to remove affected
  • stress management techniques
Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.