What is epididymitis?
Epididymitis
is an inflammation of the coiled tube (epididymis) at the back of the
testicle that stores and carries sperm. Although males of any age can
develop epididymitis, it occurs most frequently between ages of 20 to
39. When it develops in children, it is usually due to inflammation
caused by trauma. However, some children develop it because of bacterial
infections, some of which may be due to sexual abuse.
What are epididymitis causes?
The
cause of epididymitis is usually a bacterial infection. The bacteria
usually get to the epididymis by moving back through (retrograde) the
urethra, prostate, vas deferens into the epididymis. The responsible
bacteria are usually identified in about 80% of cases.
Two
main groups of organisms cause most cases of epididymitis: sexually
transmitted organisms and coliforms (organisms that commonly live in the
intestines).
- In men younger than about 39 years of age,
the causes are usually the same organisms that cause the sexually
transmitted diseases of chlamydia (responsible for nearly 50%-60% of
cases) and gonorrhea. The bacterial species are Chlamydia trachomatis
and Neisseria gonorrhea, respectively.
- In those older than 39
years of age, the causes are usually coliforms, which are bacteria
(such as Escherichia coli) that live in the intestines. These organisms
also frequently cause bladder infections. Any age of men who participate
in anal intercourse are more likely to get infected with E. coli or
other fecal bacteria. Epididymitis is rarely caused by fungi or
Mycobacterium spp.
- Chemical epididymitis (rare) is
inflammation caused by the retrograde (backward) flow of urine when
exercising or having sex with a full bladder.
- Amiodarone (Nexterone), a frequently used heart medication, occasionally causes inflammation of the epididymis.
- Viral infections (including mumps), mainly in the pediatric population.
What are dpididymitis symptoms?
Epididymitis symptoms 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
- 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 Chronic epididymitis
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.
How is epididymitis diagnosed?
Your
doctor will do 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:
Sexually transmitted infection (STI) 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 may use this test if your symptoms began with sudden,
severe pain and other tests have not been definitive.
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.
How is epidiymitis treated?
The
health care practitioner likely will treat the individual with
antibiotics through an IV, a shot, or pills orally (to be taken for 10
days or longer). Often the treatment depends on the identity of the
infecting bacteria; many physicians elect to treat with at least two
different antibiotics because individuals are occasionally infected with
more than one organism.
For men younger than 39 years of age,
Ceftriaxone, Azithromycin, and Doxycycline are often prescribed. For men
older than 39 years od age or those who participate in anal
intercourse, Ciprofloxacin, Ofloxacin, Sulfamethoxazole and trimethoprim
are often prescribed.
The CDC guidelines recommend that for
acute epididymitis
most likely caused by enteric organisms or with negative gonococcal
culture or PCR nucleic acid amplification test the following:
Ofloxacin (Floxin) 300 mg orally twice a day for 10 days or levofloxacin 500 mg orally once daily for 10 days.
Guidelines change frequently; most health care practitioners who treat
epididymitis are aware of these guidelines, and depending on local
resistance patterns of pathogens, may change the type and duration of
antibiotics to best fit the patient's condition. Pediatric treatments
are best administered by pediatricians and are usually based on the
weight of the patient and the infecting organism's antibiotic
susceptibility. If the infection is not treated early, complications may
develop that require surgery.
For patients with non-infectious
causes of epididymitis (for example, chemical, inflammation)
anti-inflammatory medication is often prescribed; occasionally,
consultation with a urologist is recommended for additional treatments.
