Epididymitis is an inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm. Pain and swelling are the most common signs and symptoms. Males of any age can get epididymitis, but it's most common in men between the ages of 19 and 35.
Epididymitis is most often caused by a bacterial infection or by a sexually transmitted disease (STD) such as gonorrhea or chlamydia. In some cases, the testicle may also become inflamed — a condition called orchitis.
Signs and symptoms
The signs and symptoms of epididymitis depend on the cause. They can include:
A tender, swollen, red or warm scrotum
Testicle pain and tenderness, usually on one side — the pain may get worse when you have a bowel movement
Painful urination or an urgent or frequent need to urinate
Painful intercourse or ejaculation
Chills and a fever that can last up to six weeks
A lump on the testicle
Enlarged lymph nodes in the groin (inguinal nodes)
Pain or discomfort in the lower abdomen or pelvic area
Discharge from the penis
Blood in the semen
Signs and symptoms of epididymitis usually develop over a day or two and get better with treatment. In some cases, epididymitis may not clear up completely, or may recur. This is known as chronic epididymitis. Symptoms of chronic epididymitis may come on gradually. Sometimes the cause of chronic epididymitis is not identified
Epididymitis has a number of causes, including:
Sexually transmitted disease (STD). STDs, particularly gonorrhea and chlamydia, are the most common cause of epididymitis in young, sexually active men.
Other infections. Boys, older men and homosexual men are more likely to have epididymitis caused by a non-sexually transmitted bacterial infection. For men who've had urinary tract infections or prostate infections, bacteria may spread from the infected site to the epididymis. Rarely, epididymitis is caused by a fungal infection.
The heart medication amiodarone. In some cases, this anti-arrhythmic medication causes inflammation of the epididymis. Epididymitis caused by amiodarone is treated by reducing the dose of amiodarone or by changing medications.
Tuberculosis. In some cases, tuberculosis can cause epididymitis.
Urine in the epididymis. Known as chemical epididymitis, this occurs when urine flows backward into the epididymis. It most commonly occurs with heavy lifting or straining.
Sexually transmitted epididymitis
Several factors increase your risk of getting epididymitis caused by an STD, including:
High-risk sexual behaviors, such as having multiple sex partners, having sex with a partner with an STD, and having sex without a condom.
Personal history of an STD. You're at increased risk of an infection that causes epididymitis if you've had an STD in the past.
Several things increase your risk of epididymitis caused by an infection other than an STD, including:
Past prostate or urinary tract infections. Chronic urinary tract infections or prostate infections are linked to bacterial infections that can cause epididymitis.
Being uncircumcised or having an anatomical abnormality of the urinary tract. These conditions increase your risk of epididymitis caused by a bacterial infection.
Having a medical procedure that affects the urinary tract. Procedures such as surgery or having a urinary catheter or scope inserted into the penis can introduce bacteria into the genital-urinary tract, leading to infection.
Prostate enlargement. Having an enlarged prostate that obstructs bladder function and causes urine to remain in the bladder puts you at higher risk of bladder infections, which increases the risk of epididymitis.
When to seek medical advice
Never ignore scrotal pain or swelling. A number of conditions can cause testicular pain, and some of the conditions require immediate treatment. Some conditions that cause scrotal pain or swelling can get worse or cause permanent damage if not treated promptly. See a doctor if you have discharge from your penis or pain when you urinate. Testicular torsion, caused by a twisted spermatic cord, can cause pain similar to that caused by epididymitis and requires emergency treatment because it blocks blood flow to the testicle.
Screening and diagnosis
Your doctor will conduct a physical exam, which may reveal enlarged lymph nodes in your groin and an enlarged testicle on the affected side. Your doctor also may do a rectal examination to check for prostate enlargement or tenderness and order blood and urine tests to check for infection and other abnormalities.
Other tests your doctor might order include:
STD screening. This involves obtaining a sample of discharge from your urethra. Your doctor may insert a narrow swab into the end of your penis to obtain the sample, which is then tested for the presence of bacteria or other infectious organisms. The results can be used to select the most effective antibiotic for treatment.
Ultrasound imaging. This noninvasive test uses high-frequency sound waves to create images of structures inside your body and is used to rule out conditions such as twisting of the spermatic cord (testicular torsion) or a testicular tumor. Your doctor is likely to use this test if your symptoms began with sudden, severe pain. If the ultrasound shows increased blood flow to your testicle, it supports a diagnosis of epididymitis.
Nuclear scan of the testicles. Also used to rule out testicular torsion, this test involves injecting trace amounts of radioactive material into your bloodstream. Special cameras then can detect areas in your testicles that receive less blood flow, indicating torsion, or more blood flow, supporting the diagnosis of epididymitis.
Epididymitis may eventually cause:
Scrotal abscess, when infected tissue fills with pus
Chronic epididymitis, which can occur when untreated acute epididymitis leads to recurrent episodes
Shrinkage of the affected testicle (atrophy)
Impaired fertility, but this is rare
If the condition spreads from your epididymis to your testicle, the resulting condition is known as epididymo-orchitis. Signs, symptoms and treatment options are basically the same as they are for epididymitis.
Epididymitis caused by a sexually transmitted disease (STD) or other infection is treated with antibiotic medications. Your sexual partner will also need treatment. Make sure your doctor is aware of any other medications you're taking or any allergies you have. This information, as well as determining what type of infection you have, will help your doctor select the best treatment.
Be sure to take the entire course of antibiotics prescribed by your doctor, even though you may get relief from your symptoms in two to three days after you start treatment. If you're not feeling better in that time, contact your doctor. When you've finished your medication, it's a good idea to return to your doctor for a follow-up visit to be sure that the infection has cleared up.
In most cases, symptoms improve after a few days of antibiotics. If your symptoms don't improve as expected, your doctor may try another antibiotic. If symptoms still don't improve, your doctor may do further tests to determine whether your epididymitis is caused by something other than a bacterial infection or STD.
If a pocket of pus (abscess) has formed, it may need to be drained, and in some cases part or all of the epididymis needs to be removed surgically. Surgery is sometimes necessary if epididymitis is due to underlying physical defects or if epididymitis is caused by tuberculosis.
If your epididymitis was caused by an STD, your partner will also need treatment. If your partner doesn't get treatment, you may contract the STD again. Safer sexual practices, such as monogamous sex and condom use, help protect against STDs that can cause epididymitis.
If you have recurrent urninary tract infections or other risk factors for epididymitis, your doctor may discuss with you other ways to prevent epididymitis from recurring.
Having epididymitis usually means you're experiencing considerable pain and discomfort. To ease your symptoms, try these suggestions:
Rest in bed. Depending on the severity of your discomfort, you may want to stay in bed one or two days.
Elevate your scrotum. While lying down, place a folded towel under your scrotum.
Wear an athletic supporter. A supporter provides better support than boxers do for the scrotum.
Apply cold packs to your scrotum. Wrap the pack in a thin towel and remove the cold pack every 30 minutes or so to avoid damaging your skin.
Don't have sex until your infection has cleared up. Ask your doctor when you can have sex again.
Adapted from: Mayo Foundation for Medical Education and Research