Epididymitis

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is epididymitis?

Epididymitis is the inflammation (swelling) of the epididymis, a structure in the male reproductive organs that joins the testis and the vas deferens. Inflammation of the epididymis may result in scrotal swelling, pain, penal discharge, blood in the semen, and fever.

Epididymitis is a common urological disease in men and is the most common cause for scrotal pain. It is most commonly seen in men who are 19 to 35 years of age. In this age group, most cases result from the sexually transmitted infections gonorrhea and chlamydia. Escherichia coli is the most common cause of epididymitis in older men (Source: NIH).

Epididymitis often develops as a result of a bladder or urethral infection that moves to the epididymis. In children, mumps and other viral infections may cause epididymitis. In rare cases, retrograde movement of urine is responsible for chemical epididymitis. The heart medication amiodarone has also been associated with epididymitis.

The signs and symptoms of epididymitis may begin slowly and worsen significantly within a day. The disease course varies among individuals, as some boys and men with epididymitis have no symptoms at all, while others may have severe swelling, pain and discharge. Epididymitis is generally treated with antibiotics.

In some cases, symptoms that seem to suggest epididymitis are actually from a serious condition called testicular torsion. Seek immediate medical care (call 911) for a rapid, severe onset of testicular pain or scrotal swelling and nausea with or without vomiting.

Seek prompt medical care if you are being treated for epididymitis but mild symptoms recur or are persistent.

What are the symptoms of epididymitis?

Epididymitis causes inflammation of the epididymis and may result in a number of symptoms. The symptoms can vary in intensity among individuals.

Common symptoms of epididymitis

At times any of these common symptoms of epididymitis can be severe:

  • Abdominal pain or pressure

  • Blood present in semen

  • Difficult or painful urination, or burning with urination (dysuria)

  • Discharge or pus from the end of the penis

  • Fever

  • Groin swelling and pain

  • Pain associated with ejaculation

  • Pain in the testicle

  • Testicle lump

Symptoms that might indicate a serious condition

In some cases, symptoms that seem to suggest epididymitis are actually signs of a serious condition called testicular torsion. Seek immediate medical care (call 911) if you, or someone you are with, have these serious symptoms:

  • Nausea with or without vomiting

  • Rapid, severe onset of testicular pain or scrotal swelling

  • Severe abdominal pain

What causes epididymitis?

Epididymitis is the inflammation (swelling) of the epididymis, a structure in the male reproductive system. Most cases result from the sexually transmitted infections gonorrhea and chlamydia. Escherichia coli is the most common cause of epididymitis in older men, but other types of bacteria, including Mycobacterium and Ureaplasma, may also cause the condition.

Epididymitis commonly develops as the result of a bladder or urethral infection that moves to the epididymis. In children, mumps and other viral infections may cause epididymitis. In rare cases, retrograde movement of urine is responsible for chemical epididymitis. The heart medication amiodarone has also been associated with epididymitis.

What are the risk factors for epididymitis?

A number of factors increase the risk of developing epididymitis. Not all men with risk factors will get epididymitis. Risk factors for epididymitis include:

  • Frequent catheter use

  • Multiple sex partners

  • Not vaccinated with the mumps vaccine

  • Participation in anal sex

  • Recent urinary tract surgery or structural abnormality

  • Sex without a condom

  • Uncircumcised penis

Reducing your risk of epididymitis

You may be able to lower your risk of epididymitis by:

  • Being vaccinated with the mumps vaccine

  • Being in a monogamous sexual relationship

  • Practicing safe sex, including use of a condom

How is epididymitis treated?

Treatment for epididymitis begins with seeking medical care from your health care provider. It is important to follow your treatment plan for epididymitis precisely and take all of your medications as instructed.

The goal of treatment for epididymitis is to alleviate the infection, reduce inflammation, and relieve pain, swelling and fever. Antibiotics are administered based on the exact bacterial cause of an infection. When applicable, sexual partners should be notified and treated. If the medication amiodarone is the cause of epididymitis, the dosage may be lowered or a new drug will be prescribed. If pain medication is needed, nonsteroidal anti-inflammatory agents, such as ibuprofen (Advil, Motrin), may be prescribed.

Antibiotic therapy for epididymitis that is related to sexually transmitted infections

Treatment for epididymitis caused by sexually transmitted infections (STIs) includes a combination of medication options such as:

Antibiotic therapy for intestinal organism related epididymitis

Treatment for epididymitis caused by intestinal organisms includes a combination of medications such as:

  • Ciprofloxacin (Cipro)

  • Ofloxacin (Floxin)

  • Sulfamethoxazole and trimethoprim (Bactrim DS)

Treatment to relieve symptoms of epididymitis

To relieve pain and swelling associated with epididymitis, treatment includes the following:

  • Bed rest

  • Elevation of the scrotum

  • Icing of the scrotum

  • Nonsteroidal anti-inflammatory agents such as ibuprofen (Advil, Motrin)

What are the potential complications of epididymitis?

Complications of untreated epididymitis can be serious. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of epididymitis include:

  • Infarction of the testicular tissue

  • Infertility

  • Orchitis (testicular inflammation)

  • Recurring epididymitis (chronic)

  • Scrotal abscess

  • Testicle removal

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 9
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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