Epididymitis

Epididymitis only affects men. It is an inflammation of the epididymis (tubes that carry sperm from the testes). It is usually caused by the bacterial sexually transmitted diseases (STDs) chlamydia and gonorrhea in young heterosexual men. In older men, children, and homosexual men the cause is commonly not sexually transmitted. Epididymis can be acute (newly acquired or short-term) or develop into a chronic (persistent or long-term) problem. Acute cases can be cured with antibiotics, while chronic cases can be treated, but usually not cured.

Symptoms of epididymis can include pain and swelling of a testicle, tenderness and swelling in the groin, blood in the semen, penile discharge, pain when urinating, pain during sexual intercourse, or pain when ejaculating.

Causes / Risks

Epididymitis can occur when an infection of the urinary tract or prostate spreads to the epididymis (tubes that carry sperm from the testes). In young heterosexual men, the spreading infection is commonly caused by the bacterial sexually transmitted diseases (STDs) chlamydia and gonorrhea. Less commonly, another STD or an organism that is not sexually transmitted can be a cause. In homosexual men, children, and older men, epididymitis is usually caused by an organism that was not sexually transmitted.

For men who are over 40 and have a history of urinary tract infections (UTIs) or prostate infections, the most common cause of epididymitis is the spread of the infection to the epididymis.

A noninfectious cause is the use of amiodarone, an anti-arrhythmic medication. However, in these cases the inflammation is only limited to head of the epididymis.

Sexually active men who have more than one sexual partner and do not use latex condoms are at a higher risk of developing an infection that leads to epididymitis. Men who have anatomical abnormalities in their urinary tract also have an increased risk.

Recent surgery or inserting a catheter into the penis can introduce bacteria into the urinary tract, which can lead to infection and epididymitis.
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Symptoms

The first symptoms of epididymitis are usually chills and fever and a heavy sensation in a testicle. The affected testicle will also become increasingly sensitive to traction or pressure. That testicle will eventually swell and may produce severe pain that can be aggravated by bowel movements. Swelling and tenderness could also occur in the groin area on the same side as the affected testicle.

Other symptoms that could be experienced include painful urination, pain during intercourse or ejaculation, blood in the semen, or penile discharge.

These symptoms usually present themselves over a day or two in cases of acute (newly acquired or short-term) epididymitis. They usually are severe and clear up with treatment. For chronic (persistent or long-term) epididymitis, symptoms usually come on gradually and treatment can not clear them up, but may improve them.
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Testing / Diagnosis

A health care provider will perform a physical exam of the genital area. If he or she finds an enlarged testicle and enlarged lymph nodes in the groin, both being tender to the touch, it could indicate epididymitis. The health provider could also perform a rectal exam to check and see if the prostate is tender or enlarged, and could order tests to be performed on blood and urine.

The health care provider could also take a sample of the penile discharge to be screened for sexually transmitted diseases (STDs). Tests to rule out other causes of the symptoms are ultrasound imaging and nuclear scanning of the testicles.
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Treatment

Epididymitis can be treated and cured with the antibiotics azithromycin (Zithromax), ciprofloxacin (Cipro), ceftriaxone (Ceftin), doxycycline (Doryx, Vibramycin), and a trimethoprim and sulfamethoxazole (Bactrim, Septra) combination. If there is severe inflammation, a non-steroidal anti-inflammatory drug (NSAID) may be prescribed.

Depending on the degree of the infection, hospitalization may be required and if an abscess (inflamed tissue surrounding a collection of pus) has formed, surgery will be needed to drain it. For those who do not need hospitalization, bed rest and applying an ice pack to the swollen areas is recommended.

If an anti-arrhythmic medication is the cause, the only affective treatment is reducing the dose of the medication or switching to a different medication.
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Complications

Untreated acute (newly acquired or short-term) epididymitis could develop into chronic (persistent or long-term) epididymitis. Chronic epididymitis is reoccurring episodes of epididymitis that are more difficult to treat. Leaving it untreated could also allow the infection that causes it to spread to other areas and organs of the body leading to further conditions and illnesses.

Other complications of epididymitis include atrophy (shrinkage) of the affected testicle, the development of an abscess (inflamed tissue surrounding a collection of pus), or in rare cases, infertility.
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Prevention

Untreated chlamydia and gonorrhea are the most common causes of epididymitis. Since those are both bacterial sexually transmitted diseases (STDs), they can be prevented by abstaining from sexual contact, having sex with an uninfected partner in a monogamous relationship, or properly using latex condoms.

Men who think they may be experiencing symptoms of an STD should see a health care provider. Having an STD treated can prevent the STD from developing into epididymitis. Men who have reoccurring urinary tract infections or other risk factors should discuss ways with a health care provider to prevent reoccurring episodes of epididymitis.
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