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Epididymitis

Definition

Epididymitis is swelling (inflammation) of the tube that connects the testicle with the vas deferens. The tube is called the epididymis.

Causes

Epididymitis is most common in young men ages 19 to 35. It is most often caused by the spread of a bacterial infection. Infection often begins in the urethra, the prostate, or the bladder. Gonorrhea and chlamydia infections are most often the cause the problem in young heterosexual men. In children and older men, it is more commonly caused by E. coli and similar bacteria. This is also true in homosexual men.

Mycobacterium tuberculosis (TB) can cause epididymitis. Other bacteria (such as Ureaplasma) may also cause the condition.

Another cause of epididymitis is the use of a medicine called amiodarone, which prevents abnormal heart rhythms.

The following increase the risk for epididymitis:

Symptoms

Epididymitis may begin with a low fever, chills, and a feeling of heaviness in the testicle area. The area will get more sensitive to pressure and become painful as the condition progresses. An infection in the epididymis can easily spread to the testicle.

Other symptoms include:

Exams and Tests

Physical exam will show a red, tender lump on the affected side of the scrotum. Tenderness is most often centered in a small area of the testicle where the epididymis is attached. A large area of swelling may develop around the lump.

The lymph nodes in the groin area may also be enlarged, and there may be discharge from the penis. A rectal exam may show an enlarged or tender prostate.

These tests may be performed:

This condition may appear like testicular torsion, in which the blood supply to the testicle is cut off. It is important to make the distinction because testicular torsion is an emergency. Surgery is needed as soon as possible in a case of testicular torsion..

Treatment

Your health care provider will prescribe medicine to treat the infection. Sexually transmitted infections need specific antibiotics. Your sexual partners should also be treated. You may need pain medicines and anti-inflammatory medications.

If the condition is caused by taking amiodarone, you will need to lower your dose or change your medicine.

To ease discomfort:

You will need to follow up with your health care provider to make sure the infection has cleared completely.

Outlook (Prognosis)

Epididymitis most often gets better with antibiotic treatment. There are no long-term sexual or reproductive problems in most cases. However, the condition may return.

Possible Complications

Complications include:

Sudden and severe pain in the scrotum is a medical emergency. You need to be seen by a health care professional right away.

When to Contact a Medical Professional

Call your health care provider if you have symptoms of epididymitis. Go to the emergency room or call the local emergency number (such as 911) if you have sudden, severe testicle pain or pain after an injury.

Prevention

You can prevent complications from epididymitis by getting diagnosed and treated early.

Your doctor may prescribe antibiotics before a surgery that could raise the risk for epididymitis. Practicing safe sex (including avoiding multiple sexual partners and using condoms) may help prevent epididymitis caused by sexually-transmitted diseases.

References

Geisler GM. Diseases caused by chlamydiae. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 326.

Nickel JC. Inflammatory conditions of the male genitourinary tract: Prostatitis, and related conditions, orchitis, epididymitis. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 11.


Review Date: 9/29/2014
Reviewed By: Scott Miller, MD, urologist in private practice in Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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