Epididymitis
Epididymitis
About epididymis
The epididymis is a series of small tubes that collects and stores sperm. It is attached to the back of each testicle.
One of the most common causes of pain in the scrotum is epididymitis. An inflammation of these coiled tubes – which may be due to an infection.
Epididymo-orchitis is the spread of the infection to the testicle.
Epididymitis is usually a secondary bacterial infection that can be triggered by a range of conditions – such as an
urinary tract infection (UTI)
or a
sexually transmissible infection (STI)
.
The bacteria in the urethra (the tube carrying urine and sperm from the penis) move through the urinary and reproductive structures to the epididymis.
Treatment options include antibiotics and bed rest.
Some people develop chronic epididymitis – which is inflammation even when there is no infection.
Image showing epididymis, courtesy Cancer Council Australia
Epididymitis symptoms
The symptoms of epididymitis include:
swollen (enlarged), red or warm testicle
feeling of heaviness in the affected testicle
tenderness or pain in the affected testicle
pain in the abdomen or pelvis
frequent urge to urinate
burning feeling when urinating
discharge from the penis
blood in the urine
pain when ejaculating
slight
fever
chills.
Epididymitis causes
Most cases of epididymitis are caused by bacterial infection. Causes include:
urinary tract infections (UTIs)
sexually transmissible infections (STIs)
(such as
chlamydia
or
gonorrhoea
)
recent genito-urinary surgery – including
prostatectomy
(surgical removal of all or part of the
prostate gland
)
the use of a
urinary catheter
some congenital
kidney and bladder problems
.
Complications of epididymitis
If left untreated, acute epididymitis can lead to a range of complications, including:
Chronic epididymitis
– the inflammation can become persistent, even when there is no bacterial infection present.
Abscess
– a ball of pus can accumulate inside the epididymis or nearby structures, requiring surgery to drain the pus.
Destruction of the epididymis
– inflammation can cause permanent damage or destroy the epididymis and testicle. This can lead to
infertility
.
Spread of infection
– the infection can spread from the scrotum to any other structure or system of the body.
Diagnosing epididymitis
It can be hard to tell the difference between epididymitis and testicular torsion – especially in younger people.
Testicular torsion
Testicular torsion
is when the testicle has twisted and cut off its supply of blood. Testicular torsion is a surgical emergency and assessment should be made at a hospital emergency department.
Sometimes, epididymitis and testicular torsion occur at the same time.
Epididymitis can be diagnosed through:
physical examination
medical history
urine tests
STI tests
blood tests
ultrasound
of the testes.
Epididymitis treatment
Treatment options for epididymitis include:
antibiotics
antibiotics for any sexual partners (if an STI was the cause)
bed rest
pain-relieving medication
cold compresses applied regularly to the scrotum
elevation of the scrotum
a stay in hospital
(in cases of severe infection)
a check-up afterwards to make sure the infection has cleared up. If symptoms have not improved after 48-72 hours, diagnosis should be re-evaluated.
Chronic epididymitis
Some people develop chronic epididymitis. This is inflammation where there has been no infection for at least 3 months.
The cause is not known. It is thought that hypersensitivity of certain structures (including nerves and muscles) may play a part.
Some of the known risk factors for chronic epididymitis include:
genito-urinary surgery
exposure to STIs
past acute epididymitis.
Even if you don’t have any of these risk factors, you can still develop chronic epididymitis.
Diagnosing chronic epididymitis
Tests are needed to distinguish chronic epididymitis from other disorders that cause constant scrotal pain. Such as
testicular cancer
, enlarged scrotal veins (varicocele) or a
cyst
in the epididymis.
Tests may include physical examination and ultrasound.
Treatment for chronic epididymitis
Chronic epididymitis is difficult to treat. Antibiotics should not be used, as there is no infection. Treatment options include:
frequent warm baths
non-steroidal anti-inflammatory medication (NSAIDs)
medication to alter nerve messages to the scrotum
rarely, surgery to remove the affected epididymis
stress management techniques
.
Where to get help
Your GP (doctor)
Your school nurse or school welfare coordinator (Some secondary schools provide access to an adolescent health trained GP on site)
Your
pharmacist
External Link
Sexual Health Victoria
(SHV)
External Link
. To book an appointment call SHV Melbourne CBD Clinic:
(03) 9660 4700
or call SHV Box Hill Clinic:
(03) 9257 0100
or (free call):
1800 013 952
. These services are youth friendly.
Melbourne Sexual Health
Centre
External Link
Tel.
(03) 9341 6200
or
1800 032 017
.
Thorne Harbour
Health
External Link
(formerly Victorian AIDS Council) Tel.
(03) 9865 6700
or
1800 134 840
Ballarat Community Health Sexual Health
Clinic
External Link
Tel.
(03) 5338 4500
Bendigo Community Health Sexual Health
Clinic
External Link
Tel.
(03) 5434 4300
Or
(03) 5448 1600
Gateway Health Clinic
35
External Link
, Wodonga Tel.
(02) 6022 8888
or
1800 657 573
Sunraysia Community Health
Services
External Link
Tel.
(03) 5022 5444
Barwon Health Sexual Health
Clinic
External Link
Tel.
(03) 5226 7489
Victorian Aboriginal Health
Service
External Link
Tel:
(03) 9419 3000
Women’s sexual and reproductive health hubs
(throughout Victoria)
1800MyOptions
External Link
Tel:
1800 696 784
is a statewide phone service for information about sexual health as well as contraception and pregnancy options