Epididymitis is inflammation of the long, narrow, tightly coiled tube (epididymis) found behind each testicle. The epididymis carries sperm from the testicle to the spermatic duct. Affected individuals usually have painful swelling of the one epididymis and the associated testicle. In some cases, the second testicle may also be tender. In addition, affected individuals have fever, painful swelling and redness (erythema) of the scrotum, and/or inflammation of the tube from which urine is carried from the bladder (urethritis). Pain associated with epididymitis can be severe. The two main forms of epididymitis are the sexually-transmitted form and the nonspecific bacterial form
Epididymitis usually has a sudden onset (i.e., one to two days), with symptoms of fever, chills, and/or pain and/or redness (erythema) of the scrotum. The epididymis behind the testicle may be swollen and tender along with the adjacent testicle. When the testicle is inflamed and swollen it is referred to as orchitis. In some cases, the second testicle may also be tender. The pain associated with epididymitis can be severe.
Affected men may also exhibit an abnormal accumulation of fluid (edema) in the scrotal skin, inflammation of the spermatic cord, the need to urinate frequently (polyuria) and/or painful urination.
In addition, epididymitis may be associated with inflammation of or discharge from the tube from which urine is carried from the bladder (urethritis), urinary tract infections, scrotal abscesses that form when infected tissue fills with pus, and/or inflammation of the prostate (prostatitis). A lump may be found on the testicles in some cases and the lymph nodes in the groin region may be enlarged (lymphadenopathy). In extremely rare cases, fertility may be affected. In most cases, only one epididymis is affected, but the involvement of both can occur.
Most cases of epididymitis develop rapidly over a couple days and resolve with treatment. In some cases, epididymitis does not resolve completely and may recur periodically. This is known as chronic epididymitis.
Epididymitis may have a number of different causes, including bacterial infection (e.g., infection by the sexually transmitted bacteria Neisseria gonorrhoeae or Chlamydia trachomatis); as the result of tuberculosis; or as a complication of prostate disorders, such as inflammation of the prostate (prostatitis).
In men under 35 years of age, most cases are a result of gonorrhea or chlamydia. These cases of epididymitis are often associated with inflammation of the tube from which urine is carried from the bladder (urethritis).
In men over 35 years of age, most cases of epididymitis are caused by infection with coliform gram-negative bacteria, such as enterobacteriaceae or pseudomona species. These cases of epididymitis are often associated with pus in the urine (pyuria), abnormalities of the urinary (urologic) tract, and/or recent urologic procedures (e.g., surgery).
In rare cases, epididymitis may result from trauma to the genitals. The backflow of urine into the epididymis, which often occurs from heaving lifting or straining, may also cause epididymitis.
A heart medication known as amiodarone has also been linked to epididymitis in rare cases.
Epididymitis may affect males of any age, with males between the ages of 19 and 35 are most commonly affected. Although rare, epididymitis can affect male infants or young children as well. The incidence of epididymitis is fewer than 1 in 1,000 males in the general population. Certain forms of the infection may be sexually transmitted, and sexual partners of infected individuals should seek medical evaluation.
A diagnosis of epididymitis is made based upon a thorough clinical evaluation, a detailed patient history, identification of characteristic findings and a variety of specialized tests. Such tests may include urine analysis to detect the presence of bacteria, which can cause epididymitis.
Treatment of epididymitis consists of bed rest, elevation of and placement of ice packs on the scrotum, and drug therapy to relieve pain (e.g., with analgesics). When epididymitis is caused by bacterial infection, antibiotic drug therapy is given (e.g., with ampicillin, amoxicillin or trimethoprim). Surgical drainage may be required if an abscess forms. If bacterial epididymitis occurs repeatedly due to chronic inflammation of the urethra (urethritis) or the prostate (prostatitis), additional episodes may be prevented by surgical removal of a portion of the spermatic duct (vasectomy). In those forms of epididymitis that are sexually transmitted, the sexual partner of the infected individual may also require antibiotic drug therapy.
In nonbacterial forms of epididymitis, symptoms may be relieved in some cases by nerve block of the spermatic cord with a local anesthetic.
It is very important that any pain or swelling in the scrotum receives prompt medical attention.
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
Tollfree: (800) 411-1222
TTY: (866) 411-1010
For information about clinical trials sponsored by private sources, contact:
Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:1328.
Mandell GL, Bennett JE, Dolan R. Eds. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases. 4th ed. Churchill Livingstone Inc. New York, NY; 1995:1100-1101.
Al-Taheini KM, Pike J, Leonard M. Acute epididymitis in children: the role of radiologic studies. Urology. 2008;71:826-829.
Tracy CR, Steers WD, Costabile R. Diagnosis and management of epididymitis. Urol Clin North Am. 2008;35:101-108.
Nikolaou M, Ikonomidis I, Lekakis I, Tsiodras S, Kermastinos D. Amiodarone-induced epididymitis: a case report and review of the literature. Int J Cardiol. 2007;121:e15-16.
Liu HY, Fu YT, Wu CJ, Sun GH. Tuberculosis epididymitis: a case report and literature review. Asian J Androl. 2005;7:329-332.
Haecker FM, Hauri-Hohl A, von Schweinitz D. Acute epididymitis in children: a 4-year retrospective study. Eur J Pediatr Surg. 2005;15:180-186.
Nickel JC. Chronic epididymitis: a practical approach to understanding and managing a difficult urologic enigma. Rev Urol. 2003;5:209-215.
Lau P, Anderson PA, Giacomantonio JM, Schwarz RD. Acute epididymitis in boys: are antibiotics indicated? Br J Urol. 1997;797-800.
Gordon LM, Stein SM, Ralls PW. Traumatic epididymitis: evaluation with color Doppler sonography. AJR Am J Roentgenol. 1996;166:1323-1325.
FROM THE INTERNET
Tubridy C, Sinert R. Epididymitis. Emedicine Journal, November 29 2007. Available at: http://www.emedicine.com/emerg/topic166.htm Accessed on: July 23, 2008.
Mayo Clinic for Medical Education and Research. Epididymitis. November 20, 2007. Available at: http://www.mayoclinic.com/health/epididymitis/DS00603 Accessed On: July 23, 2008.