Epididymitis

What causes epididymitis?

Epididymitis can result from infection or other causes.

In sexually active adults, it's often caused by a sexually transmitted infection (STI) such as chlamydia or gonorrhea. In children and adults over 40, it can be from bacteria from other parts of the urinary tract (not an STI infection), commonly E coli bacteria.

Other infectious causes include:

• Viral infections like enterovirus, adenovirus, and influenza.

• Tuberculosis infection.

• Opportunistic infections like ureaplasma, mycobacterium, cytomegalovirus, or cryptococcus in men with HIV.

• Urinary tract infections.

Noninfectious causes include:

• Trauma.

• Repetitive activities, such as sports.

• Benign prostatic hypertrophy (an enlarged prostate).

• Testicular torsion.

• Exposure to chemicals or drugs.

Who is at risk?

Epididymitis is most common in males between ages 20 and 40. However, it can occur at any age.

What are the symptoms of epididymitis?

• Pain in the lower belly (abdomen) or lower back. The pain then spreads down into the scrotum. Often only 1 side is affected.

• Swelling, redness, and pain in the testicle and scrotum.

• Fever.

• A burning feeling when peeing.

• More frequent and urgent need to urinate.

• Sometimes, discharge from the penis.

• Blood in semen.

How is epididymitis diagnosed?

Your health care provider will do a physical exam and look for swelling of the testicles, urethral discharge, and tenderness. If there’s discharge, your provider will take a sample and have it tested for STIs.

Other tests include:

• Digital rectal exam. Your provider inserts a finger into the rectum to check for an enlarged or tender prostate.

• Ultrasonography. This test can check for inflammation of the epididymis and testis.

• Urinalysis and culture. Urine samples are checked. They may be sent to a lab to see if bacteria are growing in them.

• Blood tests. These are done to identify inflammation or infection.

How is epididymitis treated?

Treatment is with antibiotics and anti-inflammatory pain medicines. The condition should get better over the first few days of treatment. But it will take a few weeks for all the swelling and mild pain to go away.

If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

If your provider thinks that an STI is the cause, your sexual partners may also need to be treated.

Home care

Here are some home care tips:

• Support the scrotum. For older children and adults: When lying down, place a rolled towel under the scrotum. When walking, use an athletic supporter or 2 pairs of jockey-style underwear.

• To ease pain, put ice packs on the inflamed area. To make an ice pack, put ice cubes in a plastic bag that seals at the top. Wrap the bag in a clean, thin towel. Use it for 15 minutes at a time every few hours. Never put an ice pack directly on the skin.

• Take pain medicine as directed. You may use over-the-counter medicines to control pain, unless another medicine was given. If you have long-term (chronic) liver or kidney disease, or take other medicines, talk with your provider before taking these medicines. Also talk with your provider if you've ever had a stomach ulcer or digestive tract bleeding.

• Get some rest. Rest in bed for the first few days until the fever, pain, and swelling get better. It may take a few weeks for all of the swelling to go away.

• Prevent constipation. Constipation can make you strain. This makes the pain worse. Prevent constipation by eating natural laxatives. These include prunes, fresh fruits, and whole-grain cereals. If needed, use a mild over-the-counter laxative. Mineral oil can be used to keep the stools soft.

• Take all medicine as directed. Don't miss any doses. And don't stop taking your medicine early, even if you feel better.

• Teens and adults: Wait to have sex. Don't have sex until you've finished all treatment and all symptoms have cleared.

Follow-up care

Follow up with your provider, or as advised, to be sure you're responding well to treatment. If a culture was taken, you may call for the result as directed. A culture test can make sure that you're taking the right antibiotic. The outcomes for most men with epididymitis are excellent, but relapses may occur in patients who do not follow their treatment plan.

When to contact your doctor

Contact your provider right away if:

• You have a fever of 100.4ºF (38ºC) or higher, or as advised by your child's or your provider.

• You have more pain or swelling of the testicle after starting treatment.

• You feel pressure or pain that gets worse.

• You're unable to pee for 8 hours.