Epididymitis is a painful medical condition affecting part of the male reproductive anatomy. It has several possible causes and can occur at any age but is treatable with proper diagnosis and care.

What Is Epididymitis?

Epididymitis is an inflammation of the epididymis, a tightly coiled tube behind the male testicle. The epididymis connects the vas deferens to the testicles and plays a role in storing and transporting sperm for the sex act. Epididymitis can occur in males of all ages and has several causes, with bacterial infection being the most common. The pain associated with this condition ranges from mild to severe. Epididymitis responds to proper medical care.

Epididymitis is a serious health risk with some potential complications. If you are experiencing pain or swelling of the scrotum or testicles, contact your medical provider immediately. The Baptist Health urology team stands ready to help.

How Common Is Epididymitis?

Epididymitis is relatively common in the United States. More than a half-million men are diagnosed with this condition annually, primarily though not exclusively between the ages of 19 and 35 years old.

Types of Epididymitis

Acute Epididymitis

Acute epididymitis is marked by sudden onset and serious pain and related symptoms, which can worsen with time. It usually results from a bacterial infection.

Chronic Epididymitis

Chronic epididymitis is a persistent condition lasting six weeks or more. Pain and discomfort are sometimes intermittent and often less severe than with acute epididymitis.

Epididymitis Symptoms

The chief symptoms of epididymitis are pain, swelling, or dysfunction of the male genitals. These include:

• A swollen or discolored scrotum
• Bloody semen
• Increases in urinary frequency
• Painful ejaculation
• Painful urination
• Pelvic or abdominal pain
• Testicular discomfort or pain

Less common are flu-like symptoms such as fever and chills.

What Causes Epididymitis?

Epididymitis has several potential causes. Included are:

• Sexually transmitted infections (STIs): Bacterial infection is the most common source of epididymitis, including the pathogens for gonorrhea and chlamydia. STIs account for many of the epididymitis cases in sexually active younger males.
• Bacterial infections from other sources: The source bacteria for epididymitis can also be spread by prostate or urinary-tract infections with causes other than sexual intercourse.
• Trauma: Physical injury to the genitals can lead to epididymitis.
• Tuberculosis: In rare cases, epididymitis can result from a tubercular infection.
• Urinary backflow: Urinary backflow into the epididymis can result from physical strain (for example, lifting weights without proper support), where urine acts as a chemical irritant.
• Catheter use: Catheter use following surgery or as an aspect of medical treatment can irritate the epididymis.
• Enlarged prostate: An enlarged prostate can lead to bladder and urinary-tract infections.

Epididymitis can also occur as a side effect in persons taking amiodarone, an arrhythmia medication.

Risk Factors

Certain risk factors increase the likelihood of developing epididymitis. These include:

• Casual sexual behaviors, such as unprotected sex, anal sex, or sex with a person who has an STI.
• A prostate or urinary-tract infection.
• An enlarged prostate.
• An uncircumcised penis.
• Medical procedures involving the urinary tract or genitals.
• Other health conditions associated with a weakened immune system.

Potential Complications

Epididymitis can result in health complications. Included are:

• Fissures or pus-filled abscesses in the scrotum.
• Fluid buildup around the testicle, called a hydrocele.
• Death (necrosis) of testicular tissue caused by loss of blood flow.
• The spread of infection from the epididymis to the testicle, called epididymo-orchitis.
• In rare cases, a reduction or loss of male fertility.

Left untreated, cases of acute epididymitis can sometimes develop into the chronic or long-term version of this same condition.

Diagnosing Epididymitis

To diagnose epididymitis, your healthcare provider will ask you questions about your symptoms, record your medical history, and conduct a physical exam. This exam will include checking your groin for enlarged lymph nodes, swollen testicles, or other evidence of infection. Your physician may also perform a rectal exam to evaluate the health status of your prostate.

In addition, you may undergo one or more of the following tests:

• Urinalysis
• Blood test
• STI screening
• Ultrasound

Treatment for Epididymitis

Because epididymitis has a variety of causes, it has a variety of treatments. These are described below.

Bacterial Epididymitis

The primary means of treating bacterial epididymitis is with antibiotics. Antibiotic medications include:

• Ciprofloxacin
• Doxycycline
• Levofloxacin
• Trimethoprim-sulfamethoxazole

A typical course of treatment runs one to two weeks.

Tuberculosis Epididymitis

Tubercular epididymitis is treated as an aspect of the general plan for treating tuberculosis. The following antibiotics may be prescribed:

• Ethambutol
• Isoniazid-pyrazinamide-rifampin
• Rifapentine

A course of treatment may require six to nine months. In extreme cases, the surgical removal of the infected epididymis may be required, especially when the infection has spread to a testicle.

Amiodarone Epididymitis

Epididymitis is sometimes an unplanned-for consequence of taking amiodarone for arrhythmia. When this happens, it may be necessary to reduce or eliminate the use of this drug in a course of treatment. Your physician can prescribe an alternative medication for managing arrhythmia.

Treatments for Other Epididymitis Causes

The treatment of other, less common forms of epididymitis will depend on the nature of the cause. Your physician or a urinary specialist will be able to assist you.

An important aspect of treating epididymitis is learning how to cope with the pain and discomfort while receiving care. There are steps that you can take at home to reduce suffering and enhance the healing process:

• Rest as often as possible.
• Drink water and other fluids.
• Elevate and apply ice packs to your groin.
• Wear compression shorts to control swelling.
• Take over-the-counter pain medications, such as aspirin, ibuprofen, or naproxen sodium.

How Long Does It Take for Epididymitis to Heal?

Healing times for epididymitis depend on cause. Individuals with bacterial epididymitis usually feel better in a few days after beginning a course of treatment, though swelling and some discomfort may persist for several weeks. Someone with tubercular epididymitis may require nine or more months to fully heal. Persons taking amiodarone for arrhythmia typically improve as soon as their physician changes medications.

Preventing Epididymitis

Epididymitis is to a certain degree preventable. Put the odds in your favor by:

• Practicing good hygiene.
• Wearing a condom during sexual intercourse.
• Keeping up to date on all your vaccines.

When Should You Contact Your Doctor

Epididymitis is a painful inflammation of the epididymis, a tubular mass attached to the male testicles. With several potential causes, but most commonly a bacterial infection, epididymitis can affect males of any age. It is a serious and unpleasant health threat with potential complications that should be diagnosed and treated by medical professionals.

Baptist Health is committed to being a leading provider for the diagnosis and treatment of urinary and male sexual disorders in Kentucky and Southern Indiana. If you have questions or concerns about epididymitis, contact your Baptist Health primary care physician or one of our specialists.

Call to schedule a consultation today!

Epididymitis FAQs

How Long Does Epididymitis Last?

The duration of epididymitis depends on its cause. Because most cases result from a bacterial infection, many persons taking an appropriate antibiotic respond quickly to treatment. Individuals with a tubercular form of epididymitis can take much longer to heal. Arrhythmia patients taking amiodarone usually improve when they transition to a new medication. Acute forms of epididymitis sometimes respond better to treatment than chronic forms, which tend to recur intermittently over extended periods of time.

Can Epididymitis Resolve on Its Own?

Epididymitis rarely resolves on its own. Medical diagnosis and treatment are usually required to facilitate the healing process, except in rare cases with unusually mild symptoms.

What is the Difference Between Epididymitis and Orchitis?

Epididymitis and orchitis are similar infections in adjacent parts of the male anatomy. Epididymitis is an inflammation of the epididymis, the tightly wound tube that carries sperm cells from the vas deferens to the testicles. Orchitis is a similar inflammation of the testicles. When the infection starts in the epididymis and spreads to the testicles, it is called epididymo-orchitis, indicating inflammation in both structures.