General Illness Information
Common Name: None Specified
Description: Infection or inflammation of the epididymis, which is a tubular structure attached to the upper posterior part of each testicle, and results in scrotal pain.
Causes: Causes depend on the age of the patient:
- In younger men ( less than 35 ) – Sexually transmitted disease e.g.. Chlamydia or Gonorrhea and E. coli infection, associated with anogenital sex – can be seen in gay men.
- Older than age 35 – Non-sexually transmitted disease associated with prostatitis, post prostatectomy, and benign prostatic hypertrophy (obstruction leads to high voiding bladder pressures and causing reflux into the epididymis). Infection is usually due to gram-negative bacteria, namely Eschericia coli (E. coli) and Pseudomonas aeruginosa.
- In children , the infection is due to E. coli . Children presenting with epididymitis should always be investigated for underling congenital abnormalities, such as vesicouretral reflux ( reflux of urine from the bladder into the ureter) or an ectopic ureter (abnormal position of ureter).
- Also,epididymitis may occur in patient on treatment with a drug called Amiodarone (this medication is used in treatment of an irregular heart beat). This is a non-infectious epididymitis, that resolves on decreasing the drug dose.
- Use condoms during intercourse to protect from venereal disease. Don’t engage in sexual activity with persons who have venereal disease.
- Avoid urethral catheters if possible, and to use antibiotics in case of catheterization, to prevent infection.
- Seek early treatment for prostatitis.
Signs & Symptoms
- Fever and chills.
- Scrotal swelling, pain and tenderness, sometimes extending to the groin region, may begin relatively acutely over several hours.
- May have urinary symptoms, such as pain when passing urine, blood in urine and urinary frequency.
- Urethral discharge
- Recent illness, especially acute or chronic prostatitis, urethritis, or urinary tract infection.
- Indwelling urethral catheter
- Urethral stricture.
- Urethral instrumentation and transurethral surgery .g. prostatectomy.
- In children- congenital abnormalities of the urinary tract, as mentioned above under causes.
Diagnosis & Treatment
- Diagnosis of epididymitis may be suspected from the history and clinical examination . Patient usually presents with epididymal tenderness and swelling, scrotal swelling and redness, fever and possibly urethral discharge.
- Laboratory studies include: blood tests, urinalysis and culture of prostate secretions to identify the bacteria responsible for the infection so that appropriate antibiotic can be prescribed.
- Other investigations that would assist in confirming the diagnosis are : ultrasound scan and a radio nuclide scan of the scrotum.
- The goal of treatment is to combat infection and reduce pain and swelling. Treatment can usually be done at home.
- Support the weight of the scrotum and tender testicles. Roll a soft bath towel and place it between the legs under the inflamed area.
- Apply an ice pack to the inflamed parts to help reduce swelling and relieve pain. Don’t use heat.
- Wear an athletic supporter or two pairs of athletic briefs when you resume normal activity.
- An exploratory operation may be necessary to make firm diagnosis and save the testicle (rare).
- Surgical procedure may be necessary for severe cases not responding to antibiotics.
- Nerve block with a local anesthetic of the spermatic cord in severe cases.
- Ibuprofen or acetaminophen for mild pain, or stronger pain drugs can be prescribed for moderate to severe pain.
- Antibiotics to fight infection.
- Stool softeners.
Rest in bed until fever, pain and swelling improve
- Don’t drink alcohol, tea, coffee or carbonated beverages. These irritate the urinary system.
- Take natural laxative foods, such as prunes, fresh fruit, whole-grain cereals and nuts, to prevent constipation.
Possible Complications :
- Sterility or narrowing and blockage of the urethra if the epididymitis involves both testicles. This requires surgery.
- Recurrent epididymitis
Usually curable with treatment. Pain usually resolves in 1-3 days, but complete healing may take weeks or months.