Epididymitis

The epididymis, a coil-like tube near the rear of the testicle, can become inflamed, which is known as epididymitis. Sperm are carried and stored in the epididymis. Any age male can develop epididymitis.

The most frequent cause of epididymitis is a bacterial infection, which includes STIs like gonorrhea and chlamydia. A testicle can occasionally become inflamed as well; this ailment is known as epididymal orchitis. Antibiotics and painkillers are frequently used to treat epididymitis.

Epididymitis: Causes

The following are the important causes of developing epididymitis −

• STIs. The most frequent causes of epididymitis in young, sexually active men are gonorrhea and chlamydia.

• Various infections. The epididymis may get infected with bacteria from a prostate or urinary tract infection. Furthermore, viral diseases like the mumps virus can cause epididymitis.

• Trauma. An epididymitis injury to the groin can occur.

• Tuberculosis. Occasionally, TB infection can lead to epididymitis.

The epididymis becomes irritated chemically when urine runs back into it, leading to this disease. It could be the result of straining or hard lifting.

Epididymitis: Symptoms

The patient will likely report scrotal discomfort and edema, which are frequently gradual rather than severe at the start. Pain in the flanks that moves to the scrotum might be the start of it. The patient may also express complaints about urinary symptoms including incontinence of urine or urgency, frequency, or dysuria. Moreover, the patient may complain of urethral discharge.

The possibility of traumatic injury or injury from repetitive activities like sports, sexual history, including a history of prior exposures to STDs, and past medical history, including problems with the genitourinary tract, such as prior urinary tract infection, prostatitis, or surgical procedures, should all be included in a thorough history.

A physical examination is likely to demonstrate scrotal edema, and probing of the scrotum is likely to reveal discomfort, often unilateral but occasionally bilateral. Epididymitis is characterized by sensitivity to palpation of the epididymis along the superior and posterior sides of the testis. The testis itself may feel tender to the touch, which might be a sign of orchitis or epididymal orchitis. Due to an infection, the skin that covers the scrotum may seem heated, erythematous, inflammatory, and indurated. Furthermore, tender inguinal adenopathy might be observed. There can be a urethral discharge visible upon physical inspection of the penis. A digital rectal exam may reveal soreness when the prostate gland is touched. Even though these results aren't always diagnostic of epididymitis, they might be related to infections of the male genitourinary tract.

Epididymitis complications include −

• Abscess, a pus-filled infection in the scrotum.

• A hydrocele is a collection of fluid around the testicle.

• If the illness progresses from the epididymis to a testicle, it is known as epididymal orchitis.

• Decreased fertility sporadically

Epididymitis: Risk Factors

You are more likely to get sexually transmitted epididymitis if you engage in certain sexual practices that might cause STIs, such as −

• Sexual activity with an STI carrier

• No-condom sexual activity

• Asexual relations

• An STI history

The following are risk factors for non-sexually transmitted epididymitis −

• Having a urinary or prostate infection

• Doing an operation in the medical setting that affects the urinary system, such as inserting a catheter or scope into the penis

• An uncivilized penis

• A deviation from the urinary tract's usual anatomy

• Increased risk of bladder infections and epididymitis due to prostate enlargement

• Other medical diseases, including HIV, that compromise the immune system

Epididymitis: Diagnosis

The diagnosis of epididymitis is mainly done based on history and some of the tests may be required for confirmation and to rule out underlying causes

Your doctor discusses your symptoms with you and examines your groin to determine whether you have epididymitis. This entails looking for larger testicles on the afflicted side and groin lymph nodes. To check for prostate enlargement or pain, your doctor may also do a rectal exam.

Testing could involve −

• STI examination. A sample of any discharge you might have is taken using a thin swab that is put into the end of your penis. Chlamydia and gonorrhea are tested for in the laboratory using the sample.

• Tests on blood and urine. Your blood and urine samples may also be sent to the lab for analysis.

• Ultrasound. Sound waves are used in this imaging exam to produce images of your testicles. If you have testicular torsion, the test might reveal it. Torsion of the testicles can stop the flow of blood and is referred to as testicular torsion. The testicle is twisted if ultrasonography with the color Doppler reveals lesser blood flow to a testicle than is usual. Blood flow that is greater than usual may indicate that you have epididymitis.

Epididymitis: Treatment

The treatment is based on the severity of the symptoms. Your doctor may advise conservative or surgical treatment.

Conservative Treatment

Antibiotics − Bacterial epididymitis and epididymal-orchitis, an epididymitis infection that has progressed to a testicle, must be treated with antibiotics. All sex partners must receive therapy if an STI is the source of the bacterial illness. Even if your symptoms go away sooner, take all of the antibiotics that your doctor has prescribed. This assists in ensuring that the infection is eliminated.

Measures for comfort − After two or three days of taking an antibiotic, you should start to feel better, but it can take a few weeks for the pain and swelling to go down. Pain can be eased by resting, using an athletic supporter to support the scrotum, using cold packs, and/or using painkillers.

Surgical Treatment

If an abscess has formed, you might need surgery to drain it. Sometimes, all or part of the epididymis needs to be removed surgically. This surgery is called an epididymectomy. The surgical repair might be done when underlying problems with the anatomy of the urinary tract lead to epididymitis.

Epididymitis: Prevention

Practice safer sex to help prevent STIs that can lead to epididymitis. Your healthcare practitioner may discuss further preventative measures with you if you have recurring urinary tract infections or other epididymitis risk factors.

Conclusion

Individuals with epididymitis brought on by the STD should avoid sexual activity until they are symptom-free, think about safe sex techniques to lower the risk of re-infection, and report sexual contacts to their primary care physician or their local health department for assessment and treatment.

Patients with epididymitis brought on by a UTI should be advised to take the full course of prescribed antibiotics, be encouraged to drink plenty of fluids to flush the genitourinary tract, and should follow up with both their primary care physician and a urologist for additional assessment and management.

Under the laws, rules, and procedures of the relevant jurisdiction, the provider should get in touch with local authorities, child protective services, or other social service organizations when they suspect sexual abuse.