Epididymitis – Introduction, Causes, and Prevention.

What is epididymitis?

Epididymitis is an inflammation of the epididymis. The epididymis is a tube located at the back of the testicles that stores and carries sperm. When this tube becomes swollen, it can cause pain and swell in the testicles.

Epididymitis can affect men of all ages, but it’s most common in men between ages 14 and 35. It’s usually caused by a bacterial infection or a sexually transmitted disease (STD). The condition usually improves with antibiotics.

Acute epididymitis lasts six weeks or less. In most cases of acute epididymitis, the testes are also inflamed. This condition is called epididymo-orchitis. It can be difficult to tell whether the testes, epididymis, or both are inflamed. That’s why the term epididymo-orchitis is commonly used. According to the Centers for Disease Control and Prevention (CDC) Trusted Source, gonorrhea and chlamydia are the most common causes in men 35 years old or younger

Chronic epididymitis, on the other hand, lasts six weeks or more. Symptoms include discomfort or pain in the scrotum, epididymis, or the testicles. This may be caused by granulomatous reactions, which can result in cysts or calcifications.

Pathophysiology of epididymitis

The pathophysiology of epididymitis is divided; Chlamydia trachomatis and Neisseria gonorrhoeae are the most common pathogens in patients younger than 35 years, whereas Enterobacteriaceae and gram-positive cocci are frequent pathogens in older patients. In either case, infection results from a retrograde ascent of infected urine from the prostatic urethra into the vas deferens and, finally, into the epididymis.

Causes of epididymitis

The spread of 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 (STI)

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

Children

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 epididymis

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 problems

Risk factors

Certain sexual behaviors that can lead to STIs put you at risk of sexually transmitted epididymitis, including having:

• Sex with a partner who has an STI
• Sex without a condom
• History of STIs

Risk factors for nonsexually transmitted epididymitis include:

• History of prostate or urinary tract infections
• History of medical procedures that affect the urinary tract, such as insertion of a urinary catheter or scope into the penis
• An uncircumcised penis or an anatomical abnormality of the urinary tract
• Prostate enlargement, which increases the risk of bladder infections and epididymitis

Symptoms

When a bacterial infection strikes, the epididymis gradually becomes swollen and painful. This usually happens on one testicle, rather than both. It can last up to 6 weeks if untreated.

You might have one or more of these other possible symptoms:

• Redness, swelling, or tenderness in the scrotum, the sac that contains the testes
• A more frequent or urgent need to pee
• A lump on your testicle
• Painful urination or ejaculation
• Fever
• Bloody urine
• Discomfort in your lower abdomen
• Enlarged lymph nodes in your groin
• A lump on your testicle

See your doctor if you have any of these symptoms.

Complications of epididymitis

If left untreated, acute epididymitis can lead to a range of complications, including:

• Chronic epididymitis – the inflammation can become persistent, even when there is no bacterial infection present
• Abscess – a ball of pus can accumulate inside the epididymis or nearby structures, requiring surgery to drain the pus
• Destruction of the epididymis – the inflammation can permanently damage or even destroy the epididymis and testicle, which can lead to infertility
• Spread of infection – the infection can spread from the scrotum to any other structure or system of the body.

How is Epididymitis diagnosed?

A health care practitioner will take a detailed history (including a sexual history), collect a urine sample, and perform a physical examination, including a prostate exam.

Laboratory Tests

• Urinalysis and urine culture: These tests aid in the diagnosis of a urinary tract infection (bladder infection).
• Urethral culture
• Urine can be tested for sexually transmitted diseases present in the urethra.
• Sometimes a swab is inserted about a one-half inch into the urethra and sent for testing (although uncomfortable, it only takes a few seconds).
• The results usually take about a day to come back to the health care practitioner, so follow-up is very important.
• The health care practitioner often also orders other tests such as a white blood cell count. A white blood cell count may be high if the infection is present. A Gram-stain of urethral exudates, in some cases, can presumptively diagnose the infecting bacteria.
• There are several rapid tests for some of the bacteria that cause epididymitis (N. gonorrhea, C. trachomatis). They detect the organisms by PCR and immunological methods. However, these tests usually require confirmation by actually culturing the bacteria.

Imaging Tests

• Ultrasound and nuclear scans help differentiate testicular torsion from epididymitis.
• CT and MRI scans are used occasionally to help determine and differentiate between many conditions that can cause some symptoms similar to epididymitis (for example, cysts, hydrocele formation (fluid-filled area), hernias, cancerous tissue, or the extent of abscesses or gangrene in swollen testicles).

The correct diagnosis of the cause of epididymitis by health care practitioners is important because an incorrect diagnosis may lead to many problems beyond the symptoms in the individual. The majority of infections involving the epididymis (over 50%) are due to sexually transmitted infectious agents or by bacteria acquired during sexual intercourse. Consequently, sexual partners of many patients should be notified and treated, even if they currently show no symptoms. However, many men (usually older than 39 years of age) and some children can acquire the disease without it being linked to sexual transmission (for example, bladder infection or chemical inflammation). Consequently, health care practitioners need to take a detailed history from the patient, and the patient has the responsibility to answer medical history questions honestly. The situation is even more complex when children have symptoms of epididymitis; most experts suggest that a Child Protective Agency be contacted if sexual abuse is suspected.

Treatment

Antibiotics are used to treat epididymitis caused by:

• STDs. A variety of antibiotics work against chlamydia and gonorrhea. These infections are the most common causes of epididymitis related to STDs. To prevent the spread of these diseases, all your sex partners should receive antibiotics as well.
• Intestinal bacteria. A variety of antibiotics work against this type of infection.

A young boy with epididymitis probably will be referred to a urologist. This doctor specializes in illnesses of the urinary tract and male reproductive organs. The urologist will check for urinary tract problems.

For epididymitis the following measures can help relieve the discomfort and may lead to quicker recovery:

• Rest in bed for a day or two.
• Elevate your scrotum with a towel.
• Apply cold packs to the painful area.
• Drink plenty of fluids, especially water.
• Take a nonsteroidal anti-inflammatory drug (NSAID) to relieve pain and inflammation. Ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) are NSAIDs.

People with severe pain in the scrotum may need prescription pain medication.

Prevention

• You can reduce your risk of developing epididymitis caused by STDs.
• Practice safe sex.
• Have sex with only one, uninfected partner.
• Use latex or polyurethane condoms during every sexual activity. This includes oral and anal sex.