Epididymitis

(Epididymo-orchitis)
Pronounced: Ep-i-did-uh-MY-tis by Michelle Badash, MS En Espaol (Spanish Version)

Definition
Acute epididymitis is an inflammation of the epididymis. This is a structure shaped like a tube that surrounds and attaches to each testicle. The epididymis helps transport and store sperm cells. Chronic epididymitis causes discomfort or pain in the epididymis. This condition can last for three months or longer. This type is less common, though. The Epididymis

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Causes
This condition is most often caused by a bacterial infection. For example: Urinary tract infection Sexually transmitted diseases (STDs), such as chlamydia and gonorrhea Infection of the urethra ( urethritis) Infection of the prostate ( prostatitis) Tuberculosis Other causes include: Injury Viral infections, such as mumps
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Genital abnormalities Treatment with amiodarone (Cordarone), a heart rhythm drug Chemotherapy to treat bladder cancer

Risk Factors
Only men can develop this condition. Risk factors include: Age: 15-30 or over 60 (In younger men, sexually transmitted bacteria are common causes. In older men, urinary tract infections are more frequent causes.) Infection of the genitourinary tract (urethra, bladder, kidney, prostate, or testicle) Narrowing of the urethra Use of a urethral catheter Infrequent emptying of the bladder Recent surgery or instrumentation of the genitourinary tract (especially prostate removal) Birth defects of the genitourinary tract Unprotected sex Disease that affects the immune system Children, even newborns, can get epididymitis, often without any associated urinary tract infection.

Symptoms
Symptoms usually develop within a day. These include: Pain in the testicles Sudden redness or swelling of the scrotum Hardness, a lump, and/or soreness in the affected testicle Tenderness in the nonaffected testicle Groin pain Chills Fever Inflammation of the urethra Pain during intercourse or ejaculation Pain and/or burning during urination Increased pain while having a bowel movement Lower abdominal discomfort Discharge from the penis

Diagnosis
Your doctor will ask about your symptoms and medical history and perform a physical exam. Tests may include: Urinalysisto check for a high white blood cell (WBC) count and the presence of bacteria Urine culture to identify the type of bacteria present Culture or other test of discharge from penis Blood testto measure the white blood cell count (WBC) Ultrasounda test that uses sound waves to examine the scrotum

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Treatment
Treatment is essential to prevent the infection from worsening. Treatment may include: Bed restThis is to keep the testicles from moving and to promote healing. You may need bed rest until the swelling subsides. AntibioticsYou will be given antibiotics to treat a bacterial infection. Many cases of epididymitis are caused by bacteria which are transmitted through sexual contact. Chlamydia is among the most common of these. If you have an STD, such as chlamydia, your partner(s) will also need treatment. Take all of your antibiotics, even if you begin to feel better. Oral anti-inflammatory medicationThis includes drugs, like ibuprofen, to help reduce swelling. Scrotal elevation and supportYou may need to wear an athletic supporter for several weeks. Hot bathsTaking baths can ease the pain and help relieve swelling. SurgerySurgery may be needed in severe cases that keep coming back. Do not have sex until you and your partner have completed treatment. If you are diagnosed with epididymitis, follow your doctor's instructions.

Prevention
The following steps can help decrease your risk: Practice safe sex. Protect yourself from STDs by using condoms. Empty your bladder as soon as you feel the need.
RESOURCES:

National Kidney Foundation http://www.kidney.org/ UrologyHealth.org http://www.urologyhealth.org/

CANADIAN RESOURCES:

Canadian Health Network http://www.canadian-health-network.ca/ The Kidney Foundation of Canada http://www.kidney.ab.ca/

REFERENCES:

Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR 2010;59(No. RR-12):1-110. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2006: epididymitis. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/std/treatment/2006/epididymitis.htm . Updated April 12, 2007. Accessed July 15, 2010. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guide: 2006. MMWR. 2006;55. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/std/treatment/2006/rr5511.pdf . Accessed February 5, 2008.
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Hori S, Sengupta A, Shukla CJ, Ingall E, McLoughlin J. Long-term outcome of epididymectomy for the management of chronic epididymal pain. J Urol . 2009 Oct;182(4):1407-1412. The Merck Manual Diagnosis & Therapy . 17th ed. Rahway, NJ: Merck & Co; 1999. Santillanes G, Gausche-Hill M, Lewis RJ. Are antibiotics necessary for pediatric epididymitis? Pediatr Emerg Care . 2011 Feb 19.

Last reviewed September 2011 by Adrienne Carmack, MD Last Updated: 9/1/2011

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