Epididymitis is an infection of the epididymis.
This organ is a system of small tubules that carries the sperm cells from the testicles to the semen vesicles annexed to the prostate.
Typical symptoms of acute infection are pain, swelling and increased temperature of the scrotum.
When the infection spreads to the adjacent testicle, it becomes orchitis. The most frequent cause is the migration of pathogens (typically Chlamydia, N gonorrhoeae and E Coli) from the urethra.
Chronic epididymitis is rare due to tuberculosis infection of the urinary tract. Other symptoms of urinary tuberculosis, as well as scrotal lump, are frequent. Discharging scrotal fistula is a late sign of untreated disease.
Epididymitis is a complication of other infections in the urinary tract:
The following sexual behaviours (risk factors) can predispose an individual to develop sexually transmitted epididymitis:
Risk factors for no sexually transmitted epididymitis:
Signs and symptoms are always:
Medical history is essential to identify the risk factors and to focus on the correct cause.
We perform the culture of a mid-stream specimen of urine. The urine culture of the first voided urine is an excellent sample to detect sexually transmitted infection.
Men with Enterobacteriaceae may require investigation for lower urinary tract abnormalities.
If tuberculosis is suspected, three sequential early morning urine samples should be cultured. We use microscopy and culture to investigate the prostate secretion, ejaculate, discharge from a draining scrotal fistula, as well as fine-needle aspiration and biopsy.
Epididymitis will not go away on its own.
The strong recommendation is antibiotic treatment with ceftriaxone, fluoroquinolones, azithromycin and doxycycline.
In severe cases, we assess the clinical response after three days after starting the treatment. Moreover, after three days, we are likely to receive the culture results and confirm or change the empiric antibiotic treatment accordingly.
Men with potential or proven STI should be evaluated at fourteen days to check cure and ensure tracing and treatment of contacts.
Do not underestimate acute epididymitis.
Torsion of the spermatic cord (testicular torsion) is the most important differential diagnosis in boys and young men.
There is a strong recommendation to see a doctor if testicular pain, swelling or lump.
The treatment must be prompt and empiric (without waiting for the lab results), especially in severe cases.
We change the antibiotic after three days in the case of no significant improvement. However, we must reconsider the antibiotic in light of the lab results.
To leave epididymitis untreated, it becomes chronic and may impact your fertility.