Epididymitis

About epididymis

The epididymis is a series of small tubes that collects and stores sperm. It is attached to the back of each testicle.

One of the most common causes of pain in the scrotum is epididymitis. An inflammation of these coiled tubes – which may be due to an infection.

Epididymo-orchitis is the spread of the infection to the testicle.

Epididymitis is usually a secondary bacterial infection that can be triggered by a range of conditions – such as an urinary tract infection (UTI) or a sexually transmissible infection (STI).

The bacteria in the urethra (the tube carrying urine and sperm from the penis) move through the urinary and reproductive structures to the epididymis.

Treatment options include antibiotics and bed rest.

Some people develop chronic epididymitis – which is inflammation even when there is no infection.

Image showing epididymis, courtesy Cancer Council Australia

Epididymitis symptoms

The symptoms of epididymitis include:

• swollen (enlarged), red or warm testicle
• feeling of heaviness in the affected testicle
• tenderness or pain in the affected testicle
• pain in the abdomen or pelvis
• frequent urge to urinate
• burning feeling when urinating
• discharge from the penis
• blood in the urine
• pain when ejaculating
• slight fever
• chills.

Epididymitis causes

Most cases of epididymitis are caused by bacterial infection. Causes include:

• urinary tract infections (UTIs)
• sexually transmissible infections (STIs) (such as chlamydia or gonorrhoea)
• recent genito-urinary surgery – including prostatectomy (surgical removal of all or part of the prostate gland)
• the use of a urinary catheter
• some congenital kidney and bladder problems.

Complications of epididymitis

If left untreated, acute epididymitis can lead to a range of complications, including:

• Chronic epididymitis – the inflammation can become persistent, even when there is no bacterial infection present.
• Abscess – a ball of pus can accumulate inside the epididymis or nearby structures, requiring surgery to drain the pus.
• Destruction of the epididymis – inflammation can cause permanent damage or destroy the epididymis and testicle. This can lead to infertility.
• Spread of infection – the infection can spread from the scrotum to any other structure or system of the body.

Diagnosing epididymitis

It can be hard to tell the difference between epididymitis and testicular torsion – especially in younger people.

Testicular torsion

Testicular torsion is when the testicle has twisted and cut off its supply of blood. Testicular torsion is a surgical emergency and assessment should be made at a hospital emergency department.

Sometimes, epididymitis and testicular torsion occur at the same time.

Epididymitis can be diagnosed through:

• physical examination
• medical history
• urine tests
• STI tests
• blood tests
• ultrasound of the testes.

Epididymitis treatment

Treatment options for epididymitis include:

• antibiotics
• antibiotics for any sexual partners (if an STI was the cause)
• bed rest
• pain-relieving medication
• cold compresses applied regularly to the scrotum
• elevation of the scrotum
• a stay in hospital (in cases of severe infection)
• a check-up afterwards to make sure the infection has cleared up. If symptoms have not improved after 48-72 hours, diagnosis should be re-evaluated.

Chronic epididymitis

Some people develop chronic epididymitis. This is inflammation where there has been no infection for at least 3 months.

The cause is not known. It is thought that hypersensitivity of certain structures (including nerves and muscles) may play a part.

Some of the known risk factors for chronic epididymitis include:

• genito-urinary surgery
• exposure to STIs
• past acute epididymitis.

Even if you don't have any of these risk factors, you can still develop chronic epididymitis.

Diagnosing chronic epididymitis

Tests are needed to distinguish chronic epididymitis from other disorders that cause constant scrotal pain. Such as testicular cancer, enlarged scrotal veins (varicocele) or a cyst in the epididymis.

Tests may include physical examination and ultrasound.

Treatment for chronic epididymitis

Chronic epididymitis is difficult to treat. Antibiotics should not be used, as there is no infection. Treatment options include:

• frequent warm baths
• non-steroidal anti-inflammatory medication (NSAIDs)
• medication to alter nerve messages to the scrotum
• rarely, surgery to remove the affected epididymis
• stress management techniques.

Where to get help

• Your GP (doctor)
• Your school nurse or school welfare coordinator (Some secondary schools provide access to an adolescent health trained GP on site)
• Your pharmacist
• Sexual Health Victoria (SHV). To book an appointment call SHV Melbourne CBD Clinic: (03) 9660 4700 or call SHV Box Hill Clinic: (03) 9257 0100 or (free call): 1800 013 952. These services are youth friendly.
• Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017.
• Thorne Harbour Health (formerly Victorian AIDS Council) Tel. (03) 9865 6700 or 1800 134 840
• Ballarat Community Health Sexual Health Clinic Tel. (03) 5338 4500
• Bendigo Community Health Sexual Health Clinic Tel. (03) 5434 4300 Or (03) 5448 1600
• Gateway Health Clinic 35, Wodonga Tel. (02) 6022 8888 or 1800 657 573
• Sunraysia Community Health Services Tel. (03) 5022 5444
• Barwon Health Sexual Health Clinic Tel. (03) 5226 7489
• Victorian Aboriginal Health Service Tel: (03) 9419 3000
• Women's sexual and reproductive health hubs (throughout Victoria)
• 1800MyOptions Tel:1800 696 784 is a statewide phone service for information about sexual health as well as contraception and pregnancy options