What is Epididymitis?
The epididymis is part of a system in the male body that includes the testes, the tube that carries sperm (the vas deferens), the prostate, the tube that brings urine out of the body (the urethra), and the bladder. Epididymitis is when the epididymis, the tube-shaped structure behind and above the testicle where sperm grow and mature before ejaculation, gets infected or inflamed. Because the epididymis is so close to the testicle, any infection or inflammation there can spread to the testicle – this condition is known as epididymo-orchitis.
What Causes Epididymitis?
Epididymitis, mainly caused by bacterial infection, is an inflammation of the tube at the back of the testicle that stores and carries sperm. This typically happens due to two main causes: the backflow of urine, especially in older men, and sexually transmitted diseases, most common in men aged between 20 to 40.
In younger boys, before they reach sexual maturity, epididymitis is usually caused by inflammation from an injury or repetitive activities, like sports. Although, it’s important to remember that sexually transmitted diseases can be a potential cause in these cases too, as they can be a worrying sign of sexual abuse.
Epididymitis can also be triggered by other factors such as chemical, drug-induced, and viral infections.
Risk Factors and Frequency for Epididymitis
Epididymitis is a condition that can affect men of all ages, but is most common in males between 20 and 39 years old, often due to a sexually transmitted disease. Half of the cases in males under 39 are caused by two particular sexually transmitted infections, Chlamydia trachomatis and Neisseria gonorrhea. For men older than 39, the most common cause is Escherichia coli, a bacteria found in the stomach.
In young males who haven’t reached sexual maturity, epididymitis can still occur. This can be due to bacterial infections or an inflammatory process. Inflammatory processes are often due to repeated activities like sports that involve lots of running and jumping.
There are other causes of epididymitis as well. One rare cause is chemical epididymitis, which can be caused by exercise or sexual intercourse with a full bladder, leading to urine flowing back into the body. Another cause can be certain medications, such as amiodarone, which is used to treat heart rhythm disorders. Lastly, viral infections like the mumps virus can cause epididymitis or a related condition called epididymo-orchitis.
Each year, more than 600,000 men in the United States experience acute scrotal pain due to epididymitis, making this the main reason for acute scrotal pain in adults.
Signs and Symptoms of Epididymitis
A patient suffering from a possible genitourinary infection often experiences uncomfortable symptoms such as scrotal pain and swelling. The pain typically develops slowly and may start as discomfort in the back that moves to the scrotum. Other associated symptoms include urinary issues such as a burning sensation when urinating, needing to urinate often, urgency to urinate, or inability to control urination. There could also be a discharge from the penis. The patient’s history should be checked for any occurrences of injury, especially from sports, sexual history with instances of sexually transmitted diseases, and any past genitourinary problems like urinary tract infections, inflammation of the prostate gland, or any surgeries.
During a physical examination, the doctor will find that the scrotum is swollen and tender to touch. In some cases, both sides of the scrotum can be tender, but usually, it is only one side. If the back and the top part of the testicle itself is tender when felt, this can suggest inflammation in epididymis, a coiled tube behind the testes. If the testicle is sensitive to touch, it can hint at the possibility of epididymo-orchitis or orchitis which are inflammations of the epididymis and testicles. The skin covering the scrotum might look warm, red, swollen, and hard due to the infection. Tender swelling in the groin area could also be noticed. Examination of the penis might reveal a discharge. A digital rectal examination may show the prostate gland is tender when touched. While these findings could indicate epididymitis – inflammation of the epididymis, they might also be present in other infections affecting the male genitourinary tract.
Testing for Epididymitis
If a male patient complains of discomfort in the scrotum, the doctor usually starts by examining the patient’s urine. This step might not provide a specific diagnosis, but it could reveal the presence of red and white blood cells, which are signs of an ongoing infection or inflammation. If the patient also exhibits symptoms of a urinary tract infection, the doctor may send the patient’s urine for further testing to determine the type of bacteria causing it.
In cases where the patient’s sexual history suggests the likelihood of a sexually transmitted disease, the doctor might also carry out a urethral swab. This means they will collect a small sample from the patient’s urethra – the tube that carries urine from the bladder out of the body – to be tested in a lab.
The doctor might also use imaging technology to get a better look at the patient’s scrotum. An ultrasound, for example, can provide detailed images not only of the testicles but also help the doctor check blood flow to the testicles. It can also show signs of inflammation in the epididymis (which stores and carries sperm) and testicles, which may indicate conditions like epididymitis or epididymo-orchitis – infections in these areas.
In some instances, a computerized tomography (CT) scan might be helpful if the patient is also experiencing pain in the area between the ribs and the hips (flank pain) and has symptoms related to issues in the urinary system, like a kidney stone (ureterolithiasis).
One very important thing to rule out when a patient complains of scrotum discomfort is testicular torsion. This is a serious condition where the spermatic cord, which provides blood flow to the testicle, gets twisted, cutting off the blood supply. It generally causes intense pain, which often starts very suddenly. However, a person’s symptoms alone may not always be enough to confirm or rule out testicular torsion. The doctor may need to consult with a specialist in urinary and reproductive health (a urologist) and perform an ultrasound.
Treatment Options for Epididymitis
Epididymitis, or inflammation of a tube near the testicles, is usually treated based on what’s causing it, like bacteria or physical activities. However, sometimes doctors may start treatment based on the most common culprits, which are typically certain types of bacteria (C. trachomatis, N. gonorrhea, E. coli).
If the epididymitis is believed to be due to a sexually transmitted infection, doctors generally use a combination of antibiotics. There are also other types of antibiotics that may be used, particularly in older patients, if the cause is suspected to be bacteria found in the gut.
Treatment often includes steps to decrease pain and swelling. Applying an ice pack can be particularly helpful in relieving these symptoms.
If the epididymitis is due to repetitive physical activity, rest and anti-inflammatory medications are usually recommended, along with wearing supportive underwear. It’s also important to have regular check-ups with your doctor to monitor how well the treatment is working.
What else can Epididymitis be?
When trying to identify epididymitis, doctors must consider a number of other conditions that can appear similar. These include:
- Pain in the testicles after a vasectomy
- Hydrocele (fluid-filled sac around the testicle)
- Orchitis (inflammation of the testicles)
- Pain that stems from the lower back or travels down the leg
- Trauma to the scrotum
- Spermatocele (a harmless cyst on the epididymis)
- Damage to the testicles
- Seminoma (a type of testicular cancer)
- Tumors in the lining of the testicles
- Urinary tract infection
What to expect with Epididymitis
Epididymitis, which is an inflammation of the epididymis (a tube located at the back of the testicles that stores and carries sperm), can become more severe due to factors such as older age, having diabetes, fever, increased levels of white blood cells, C-reactive protein (a substance produced by the liver in response to inflammation), and blood urea nitrogen (a waste product found in the blood that results from the normal breakdown of protein in the liver).
Interestingly, individuals with epididymitis caused by a sexually transmitted disease have between 2 to 5 times the risk of getting and passing on HIV. However, it is important to note that most men with epididymitis have excellent outcomes, but the condition may return in those who do not strictly follow their treatment plan.
Possible Complications When Diagnosed with Epididymitis
If epididymitis, which is inflammation of the tube at the back of the testicle, isn’t treated correctly or on time, it could lead to the following problems:
- An abscess might form in the epididymis, due to an infection
- The infection might spread to the testicle, leading to a condition called epididymo-orchitis or forming an abscess in the testicle
- Sepsis, a serious infection that spreads throughout your body, could occur if the infection is severe
- If both epididymises are inflamed, it could lead to sterility, which is an inability to conceive children, because of blockages in the small tubes around the testicles
Preventing Epididymitis
If a person is diagnosed with a condition known as epididymitis, which is an inflammation of the tube at the back of the testicles, and it is caused by a sexually transmitted disease, they should avoid any sexual activities until they show no more symptoms. Implementing safe methods during sex can also help prevent the disease from coming back again. Also, anyone who had sexual contact with the diagnosed patient should be directed to a healthcare professional or local health department for health checks and possible treatments.
Furthermore, if the epididymitis is a result of a urinary tract infection, the individual should drink lots of water. This can help clean out the urinary system. They should also take all prescribed antibiotics and follow the doctor’s instructions precisely. The patient is advised to keep in touch with their main healthcare provider, but also see a specialist known as a urologist for further examinations and treatments.
If there is a suspicion of sexual abuse, the healthcare professional should immediately inform the local authorities, child protective services, or other social service agencies. This is based on the rules of the particular area where the patient resides.
