Definition & Facts
The epididymis is the tube that transfers sperm from the testicles to the vas deferens. The sperm then stops at the seminal vesicle before exiting the urethra during ejaculation. Epididymitis is most commonly caused by bacterial infections like gonorrhea, chlamydia, and Escherichia coli infection (E. coli). It often occurs at the same time as orchitis which is the inflammation of the testicles. Infections often start in the urinary tract before migrating to the epididymis and testicles.
Epididymitis can be acute or chronic. Chronic epididymitis lasts longer than six weeks whereas acute epididymitis usually resolves in under six weeks. Chronic epididymitis can be inflammatory, obstructive, and infectious.
Symptoms & Complaints
Needing to urinate frequently and painful ejaculation may also be symptoms of epididymitis. Chronic epididymitis tends to cause less severe symptoms than acute epididymitis. Swelling and pain may be less.
Hydrocele is another common symptom of epididymitis. This is a fluid-filled cyst that accumulates inside the scrotum. Some diagnostic tests reveal multiple cysts that are present in patients with epididymitis.
Epididymitis may result from infections occurring elsewhere near the scrotum such as infections and inflammation of the urethra (urethritis), bladder (cystitis), and prostate (prostatitis). Similar to how urinary tract infections may migrate to the epididymitis, infections of the epididymitis may migrate to the testicles, causing orchitis.
Sexually transmitted diseases may also cause epididymitis. Gonorrhea and chlamydia are the two most common causes of acute epididymitis among men under 35. Certain infections of the gastrointestinal tract such as E. coli may also be transmitted sexually.
Chronic infectious epididymitis is usually caused by infection with Mycobacterium tuberculosis. Obstructive chronic epididymitis can occur after a vasectomy. This is a procedure in which the vas deferens is cut and tied to prevent sperm from the testicle from reaching the seminal vesicle and entering the ejaculate. Chronic epididymitis can also be caused by reactions to certain medications. Amiodarone is one medication known to cause chronic epididymitis; it is an antiarrhythmic agentt. Chronic epididymitis can also be caused by Behcet's disease.
Diagnosis & Tests
The diagnostic process will begin with taking a complete medical history. It is important for the clinician to ask about the patient's history of urological problems such as bladder stones and urinary tract infections. The patient's history of sexually transmitted disease and history of surgeries, especially any surgeries that may have affected the patient's testicles, are relevant. The doctor will ask about the patient's symptoms and how severe their pain is.
A physical examination will take place as will clinical urine tests. The physical exam will involve the doctor checking for any masses or tumors on the testicles. Urine will be tested for the presence of bacteria. Samples will be taken of penile discharge to test for STD's. Such cultures will test for the presence of common bacterial agents that cause gonorrhea and chlamydia. If the patient is also at risk for other STD's based on sexual history, he should be tested for those as well.
If it's possible that they have been exposed to tuberculosis, people also need to be tested for tuberculosis to see if this is the infection that is causing their epididymitis. Ultrasounds may be performed to address any hydroceles or cysts that arise among patients with epididymitis.
Diagnostic tests should try to determine if the patient has testicular torsion. This is a medical emergency in which the spermatic cord twists around the testicle's blood supply. Emergency testing may be required to determine if the source of the patient's pain is testicular torsion. The best means of testing for testicular torsion is radionuclide scanning. A Doppler ultrasound may also provide accurate diagnosis of testicular torsion.
Treatment & Therapy
Treatment will attempt to cure any underlying infections that are causing the acute epididymitis through antibiotics. Antibiotic medications that are commonly prescribed include ceftriaxone, doxycycline, levofloxacin, or ofloxacin. The latter two are typically prescribed to treat patients with inflammation caused by infections that originated in the intestines such as E. coli.
Treatment will also attempt to prevent transmission of any underlying infections to future sexual partners. Decreasing pain and reducing the likelihood of complications are additional goals of treatment of acute cases of epididymitis.
Symptoms may be reduced through bed rest and elevating the testicles. Analgesics such as over-the-counter nonsteroidal anti-inflammatory drugs and the use of cold therapy like ice packs can all help mitigate symptoms until the patient has recovered from fever and fought off any underlying infections.
In extreme cases of chronic epididymitis, surgery may be recommended if all other treatment options have failed. Orchiectomy involves the removal of one or both testicles while an epididymectomy may be performed. This procedure removes the epididymis. It has been shown to be effective in reducing pain.
Prevention & Prophylaxis
Watchful waiting is recommended for many men with chronic epididymitis of undetermined origin (idiopathic), and this involves following up on appointments as well as reassurances from the patient's health care team that the pain they are experiencing is valid but not a symptom of a life-threatening illness such as cancer.