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What is epididymitis and how is it treated?

Q: What is epididymitis? What are its causes, symptoms and treatment options?

A:Epididymitis is an inflammation or infection of the epididymis, a convoluted duct that lies on the posterior surface of the testicle. If the inflammation or infection extends to the adjacent testicle, epididymo-orchitis is present. The most common cause of intrascrotal inflammation is epididymitis. Epididymitis most often is due to the retrograde extension of organisms from the vas deferens and is rarely the result of haematogenous spread. The causative organism is identified in 80% of patients and varies according to the age of the patient. Coliform bacteria (Escherichia coli) predominate in prepubertal males. These patients require urologic evaluation for a genitourinary anomaly, which is present in as many as 50% of these patients. Epididymitis in this age group could also be secondary to a postinfectious inflammatory reaction to certain pathogens. Research has shown that boys with epididymitis had significantly elevated titres for Mycoplasma pneumoniae, enteroviruses, and adenoviruses when compared with control groups. Sexually transmitted pathogens are the organisms most often responsible for epididymitis in the patient younger than 35 years. Chlamydia trachomatis is responsible for nearly 50-60% of cases, while Neisseria gonorrhoeae is the second most common organism responsible for epididymitis. In patients older than 35 years, coliform bacteria predominate because underlying obstructive urinary disease is often present. However, sexually transmitted pathogens are still a consideration. Chemical epididymitis, which represents an inflammatory process due to the reflux of sterile urine, is a rare cause of epididymal irritation. Other rare causes of epididymitis include tuberculosis, brucellosis, and schistosomiasis. Initially, the patient may note abdominal or flank pain because cellular inflammation typically begins in the vas deferens. As the inflammation descends to the lower segment of the epididymis, the patient notes discomfort localized to the scrotum. Younger patients, or any patient with a sexually transmitted epididymitis, may note symptoms related to urethritis. A recent history of endourethral instrumentation or urinary tract infection is more common in the older patients. Symptoms

  • Scrotal pain and oedema
  • Urinary frequency, urgency, or dysuria
  • Urinary retention from bladder outlet obstruction in older patients
  • Nausea
  • Fever and chills
  • Abdominal or flank pain
  • Bilateral epididymal involvement (10%)
  • Urethral discharge
Treatment - Antibiotics should be utilized in all cases of epididymitis, regardless of a negative urinalysis or the urethral Gram stain result. Nonsteroidal anti-inflammatory agents or narcotic analgesics also generally are prescribed to patients with epididymitis.

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