Epididymitis Health Article

Definition

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

Causes, incidence, and risk factors

Epididymitis is most common in young men ages 19 - 35. It is a major cause of hospital admissions in the military.

Epididymitis is usually caused by the spread of an infection from the urethra or the bladder. The most common infections that cause this condition in young heterosexual men are gonorrhea and chlamydia. In children and older men,E. coli and similar infections are much more common. This is also true in homosexual men.

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

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

The following increase the risk for epididymitis:

• Being uncircumcised
• Recent surgery or a history of structural problems in the urinary tract
• Regular use of a urethral catheter
• Sexual intercourse with more than one partner and not using use condoms

Symptoms

Epididymitis may begin with a low-grade fever, chills, and a heavy sensation in the testicle. The testicle becomes more and more sensitive to pressure.

Other symptoms include:

• Blood in the semen
• Discharge from the urethra (the opening at the end of the penis)
• Discomfort in the lower abdomen or pelvis
• Fever
• Groin pain
• Lump in the testicle
• Pain during ejaculation
• Pain or burning during urination
• Painful scrotal swelling (epididymis is enlarged)
• Tender, swollen groin area on affected side
• Testicle pain that gets worse during a bowel movement

Signs and tests

Physical examination shows a red, tender, and sometimes swollen lump (mass) on the affected side of the scrotum. Tenderness is usually in a small area of the testicle where the epididymis is attached.

There may be enlarged lymph nodes in the groin area (inguinal nodes), and a discharge from the penis. A rectal examination may show an enlarged or tender prostate.

These tests may be performed:

• Complete blood count (CBC)
• Doppler ultrasound
• Testicular scan (nuclear medicine scan)
• Urinalysis and culture (you may need to give several specimens, including initial stream, mid-stream, and after a prostate massage)
• Tests for chlamydia and gonorrhea

It is important to distinguish this condition from testicular torsion. Testicular torsion is an emergency and should be treated with surgery as soon as possible.