Epididymitis

Overview

What is epididymitis?

Epididymitis is inflammation (swelling and irritation) of the epididymis, a tube at the back of the testicle that carries sperm. This swelling can cause intense pain in the testicle. It can occur in men of any age, though it happens most often in men between the ages of 14 and 35. There are an estimated 600,000 cases of epididymitis in the United States each year.

Symptoms and Causes

What causes epididymitis?

Most cases of epididymitis are caused by an infection, usually by the bacteria Mycoplasma or Chlamydia. These infections often come by way of sexually transmitted diseases. The bacterium E. coli can also cause the condition. Other infections, including with the mumps virus and, rarely, tuberculosis, can also cause epididymitis.

Sometimes epididymitis occurs when urine flows backward into the epididymis. This can happen as a result of heavy lifting. Other causes of epididymitis include:

  • Blockage in the urethra (the tube that carries urine from the body)
  • An enlarged or infected prostate gland (a muscular, walnut-sized gland that surrounds part of the urethra)
  • Use of a catheter (a tube that drains the bladder)
  • Traumatic groin injury

What are the symptoms of epididymitis?

Symptoms of epididymitis include:

  • Pain in the scrotum, sometimes moving to the rest of the groin
  • Swelling and redness in the testicle
  • Blood in the semen
  • Fever and chills
  • Pain when urinating

Diagnosis and Tests

How is epididymitis diagnosed?

To diagnose epididymitis, the doctor will do a physical exam, and will examine the scrotum to look for a tender area or lump. The doctor may also order a urinalysis (urine test) to look for bacteria in the urine. In some cases, doctors use an imaging test called an ultrasound to examine the scrotum.

Management and Treatment

How is epididymitis treated?

Epididymitis caused by bacteria is treated with antibiotics, most often doxycycline (Oracea®, Monodox®), ciprofloxacin (Cipro®), levofloxacin (Levaquin®), or trimethoprim-sulfamethoxazole (Bactrim®). Antibiotics are usually taken for 1 to 2 weeks.

Men who have epididymitis can also relieve their symptoms by:

  • Resting
  • Elevating the scrotum
  • Applying ice packs to the affected area
  • Drinking fluids
  • Taking anti-inflammatory medications for the pain

What are complications of epididymitis?

If epididymitis is not treated, complications can develop, including an abscess (pus-filled sac) in the scrotum. The scrotum’s skin may open because of swelling and infection.

In rare cases, epididymitis can cause fertility problems in men. Early diagnosis and treatment can help prevent these complications.

Prevention

Can epididymitis be prevented?

You can reduce your risk of developing epididymitis by:

  • Using condoms during sex
  • Avoiding strenuous lifting or physical activity
  • Minimizing long periods of sitting

Outlook / Prognosis

What is the outlook for men who have epididymitis?

Epididymitis usually does not cause any long-term problems. Most men who are treated for the condition start to feel better after 3 days, though discomfort and swelling may last weeks or even months after finishing antibiotic treatment.

It is important to finish the entire treatment recommended by your doctor. If symptoms return, follow up with your doctor. Follow-up can rule out other conditions, including a tumor or testicular cancer.

Living With

When should I call my doctor about epididymitis?

Call your doctor if you develop any symptoms of epididymitis. If your doctor confirms that your infection comes from a sexually transmitted disease, be sure to let recent sex partners know so that they can be examined and treated.

Last reviewed by a Cleveland Clinic medical professional on 02/07/2018.

References

  • Urology Care Foundation. What are Epididymitis and Orchitis? (https://www.urologyhealth.org/urologic-conditions/epididymitis-and-orchitis) Accessed 2/21/2018.
  • Centers for Disease Control and Prevention. Epididymitis. (https://www.cdc.gov/std/tg2015/epididymitis.htm) Accessed 2/21/2018.
  • American Academy of Family Physicians. Epididymitis: What You Should Know. (https://www.aafp.org/afp/2016/1101/p723-s1.html) Accessed 2/21/2018.

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