Epididymitis

What is epididymitis?

Epididymitis is an inflammation of the epididymis (the structure that is the first part of the duct draining the testis). This can occur as the result of injury or infection.

What are the causes?

Epididymitis is caused by bacterial organisms associated with urinary tract infection, sexually-transmitted diseases (such as chlamydia and gonorrhoea), prostatitis (infection of the prostate), or prostatectomy (removal of the prostate).

The risk is higher in sexually active men who are not monogamous and do not use condoms. Men who have recently had surgery or have a history of structural problems involving the genitals or urinary tract are also at increased risk regardless of their sexual behaviours.

What are the symptoms?

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

The symptoms of epididymitis include scrotal pain and swelling. The pain or swelling may be mild or severe. At times the epididymis may become so inflamed that the patient is unable to walk due to pain. There may be lower abdominal discomfort or pelvic discomfort, and urination may be associated with burning or pain. On occasion, there may be a discharge from the urethra, blood in the semen, or pain on ejaculation. The testicle may enlarge significantly.

How is it diagnosed?

Physical examination shows a tender and sometimes swollen testicle on the affected side. Tenderness can usually be localised to a small area of the testicle where the epididymis is attached. Enlarged lymph nodes in the groin area may be present. There may be a discharge from urinary meatus. A rectal internal examination may reveal an enlarged or tender prostate. The following tests may be performed:

• A urinalysis and culture
  
• Tests to screen for chlamydia and gonorrhoea
  
• A complete blood count may show leukocytosis, or increased white blood cells
  
• Gram stain of urethral discharge

What is the treatment?

Medications to treat infection are prescribed. Sexually transmitted infections require special antibiotics and the patient's sexual partners should also be simultaneously treated. Pain relieving medications may be required and anti-inflammatory drugs are often prescribed.

Bedrest, with elevation of the scrotum and ice packs applied to the area, is recommended. It is very important to have a follow-up visit with the doctor to evaluate if the infection has completely resolved.

• Antibiotic therapy
  
• Analgesics for pain control
  
• Supportive care
  
• Scrotal elevation and support
  
• Ice pack

Epididymitis usually resolves with appropriate antibiotic therapy, without any damage to sexual or reproductive abilities. Recurrence of the infection is fairly common.

Infrequently, chronic epididymitis may develop and surgery may be necessary. Although uncommon, infertility may result from chronic epididymitis.

How is it prevented?

Complications from epididymitis may be prevented by early diagnosis and adequate treatment of the infection. Preventive antibiotics are frequently given at the time of operation in which the patient is at increased risk for epididymitis. Safer sexual practices (monogamous relationships, use of barriers such as condoms) may be helpful in preventing those cases of epididymis associated with sexually-transmitted diseases.