Epididymitis
Epididymitis is an inflammation of the epididymis, the tube behind the testicle responsible for storing and carrying sperm. Epididymitis is generally characterized by pain, swelling and tenderness in the scrotum. Epididymitis most commonly affects men in their 20s or 30s, although it can occur in males of any age.
Risk Factors for Epididymitis
Patients are at increased risk of developing epididymitis if they:
- Are uncircumcised
- Have anatomical abnormalities of the urinary tract
- Use a urethral catheter
- Have had recent surgery
- Have had a recent urinary tract infection
- Have an enlarged prostate
Because epididymitis is frequently caused by a sexually transmitted disease (STD), practicing safe sex reduces the risk of developing the condition.
Causes of Epididymitis
Epididymitis is the usually the result of a spreading bacterial infection that may have begun in the urethra, prostrate or bladder and, most commonly, stems from a sexually transmitted disease.
Gonorrhea and chlamydia are the underlying infection in heterosexual men. In children, older men, and homosexual men, E.coli is the more frequent culprit. Other bacteria, such as the one that causes tuberculosis (TB) can also cause epididymitis.
A medication used to prevent abnormal heart rhythms, amiodarone, can also be a cause of the condition.
Symptoms of Epididymitis
Symptoms of epididymitis may vary depending on its cause. These symptoms may include:
- Chills or fever
- Warmth, tenderness or swelling of the scrotum
- Pain during intercourse or ejaculation
- Pain or burning during urination
- Blood in the semen
- Pain in the lower abdomen or pelvis
- Urethral discharge
- Lump on or near the testicle
- Testicular pain that increases during defecation
Epididymitis may begin with a low-grade fever, chills, and a sensation of testicular heaviness. As the epididymis progresses, the infection usually spreads to the testicle, resulting in increased pressure and pain and the manifestation of more of the above symptoms.
Diagnosis of Epididymitis
In addition to performing a physical, including a rectal, prostate examination, the physician may administer one or more of the following:
- Blood tests
- Urinalysis
- Doppler ultrasound
- Screening for STDs
- Testicular nuclear scan
If the patient is suffering from epididymitis, the physician will detect a tender swollen area on the side of the scrotum and may also find enlarge lymph nodes in the groin. Other signs of epididymitis are a discharge from the penis and the presence of an enlarged or tender prostate.
It is important for the doctor to differentiate a diagnosis of epididymitis from one of testicular torsion. The latter, in which the blood supply to the testicle is cut off, is life-threatening and requires immediate emergency care.Treatment of Epididymitis
There are several methods of treatment for epididymitis. These include:
- Bed rest
- Elevation of the scrotum
- Application of ice packs to the area
- Antibiotics
- Pain and anti-inflammatory medications
When a sexually transmitted disease is the precipitating cause of the disorder, pathogen-specific antibiotics are prescribed and sexual partners are notified. If the reason for the problem is prescribed amiodarone, a substitute medication will have to be found or the dosage will have to be altered. In severe cases of epididymitis that are unresponsive to other treatment, surgery to remove the epididymis (an epididymectomy) may have to be performed.
