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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:

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:

Other causes

There are also some more unusual causes of epididymitis:

Risk factors

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

Risk factors for nonsexually transmitted epididymitis include:

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:

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:

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

Imaging Tests

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:

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:

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

Prevention

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