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Epididymitis

Epididymitides

Epididymitis is a condition characterized by inflammation of the epididymis which is located posterior to the testicles, responsible for storing and carrying sperm. Such a kind of condition can strike males at any age.


Presentation

Epididymitis presents with the following signs and symptoms:

  • The scrotum becomes swollen, red and is warm to touch
  • Development of pain in the testicles along with tenderness
  • Urination becomes painful with an increased urge to urinate frequently
  • Painful ejaculation and intercourse
  • Presence of blood in semen
  • Pain in the lower abdominal region
  • Development of lump on testicles
  • Discharge occurs from penis

Some males with epididymitis may also suffer from low grade fever accompanied by chills [6].

Inguinal Pain
  • The physician needs to be aware that an embarrassed child may state that he has lower abdominal or inguinal pain rather than scrotal pain. A child may also minimize his symptoms out of fear.[aafp.org]
Recent Viral Illness
  • A careful history for recent viral illnesses should be included. Antibiotics, urinary tract imaging and functional studies should be used in selected cases.[ncbi.nlm.nih.gov]
Soft Tissue Mass
  • A left, soft tissue mass in the scrotum without definite metastasis or lymphadenopathy was confirmed by computed tomography (CT) and magnetic resonance imaging. A radical left orchiectomy via the inguinal approach was performed successfully.[ncbi.nlm.nih.gov]
Weight Loss
  • The typical patient presentation for paratesticular rhabdomyosarcoma (RMS) is a painless scrotal mass, or symptoms of metastasis, such as inguinal lymphadenopathy, fatigue, decreased appetite and weight loss.[emedicine.com]
Testicular Swelling
  • Age at presentation and likelihood of testicular swelling or hydrocele was not different between children with and without UTAs.[ncbi.nlm.nih.gov]
  • Early testicular swelling and tenderness that progress to a reactive hydrocele and scrotal wall erythema is common with testicular torsion.[aafp.org]
  • swelling may take several weeks to resolve completely.[netdoctor.co.uk]
  • He/she will look for testicular swelling, swelling of lymph nodes in the groin area, and penile discharge. Your doctor will use a swab to collect a sample of the discharge and test for STIs.[clicks.co.za]
Urinary Dribbling
  • We describe the unusual case of a 5-year-old boy with a 2-month history of bladder distension, urinary dribbling, and epididymitis.[ncbi.nlm.nih.gov]

Workup

A preliminary physical examination is carried out to diagnose signs and symptoms of the disease. It would reveal enlarged lymph nodes and testicles. A rectal examination may also follow to study for prostate enlargement or any accompanying tenderness. In addition to physical examination, the following tests would also be done to confirm the condition.

  • Screening for sexually transmitted infections: Swabs from urethra is collected to analyze it for the presence of gonorrhea or chlamydia.
  • Urine and blood samples are checked for abnormalities.
  • Ultrasound examination is done to rule out testicular torsion. This method is used along with color Doppler examination to evaluate the blood flow to the testicles. If the blood flow is lower than normal then it indicates testicular torsion. If the blood flow is higher than normal, then the diagnosis of epididymitis stands confirmed [7] [8].

Treatment

Since epididymitis occurs due to bacterial infection, antibiotics form the most effective treatment regime. In case the condition is caused due to sexually transmitted infections, then the partner would also require treatment through antibiotics.

Tenderness in the scrotum may take several weeks to correct and therefore, certain other methods such as application of ice packs, resting, medications can help. In addition, males are also advised to tie an athletic strap around the scrotum to relieve the tenderness.

Surgery is required when there is formation of abscess. In many cases, parts of the epididymitis may be required to be surgically removed. Such a kind of method is known as epididymectomy [9].

Prognosis

The prognosis of the condition is favorable with pain resolving within 1 to 3 days. However, the induration can take several months to get corrected. If treatment is not initiated on time, it can further lead to development of epididymal abscess. This can in turn lead to development of infertility amongst the affected population. Individuals who have developed the condition due to sexually transmitted infections should receive prompt treatment as they are at an increased risk of developing HIV infection [5].

Etiology

Bacterial infections like gonorrhea and chlamydia are known to cause epididymitis amongst the sexually active male population. Bacterial infections of the prostrate or urinary tract can extend up to the epididymis causing its inflammation. Medications such as amiodarone indicated in treatment of cardiac arrhythmias can also cause epididymytis. Bacteria responsible for causing tuberculosis known as mycobacterium tuberculosis can also cause epididymitis in rare cases.

In addition to the above mentioned causative factors, certain conditions such as uncircumcision, structural abnormalities of the urinary tract, indulging in unprotected sexual intercourse with multiple partners and use of urethral catheter regularly can predispose men to develop epididymitis [2].

Epidemiology

Epididymitis is considered to be the 5th most common urologic diagnosis in males between 18 and 50 years of age. It is also the most common cause of intrascrotal inflammation. It has been estimated that about 1 in every 1000 men develop this urologic condition. Statistics have also revealed that acute epididymitis causes more than 600,000 medical visits per year. Acute form of the condition is more common in males aged 20 to 59 years. Epididymitis is also considered to be the frequent cause of military hospitalizations [3].

Sex distribution
Age distribution

Pathophysiology

Anatomically, epididymis is a coiled tube which is located posterior to the testicles. It is responsible for storing and carrying sperm, connecting the efferent ducts of the testis to the vas deferens. Inflammation of this region due to bacterial infections or any other underlying conditions promotes development of epididymitis. Males suffering from this condition, present with scrotal pain and induration.

Epididymitis can be both acute and chronic in nature. In the acute form, the epididymal pain and swelling can continue for several days. In the latter form, the pain and inflammation of the epididymis can continue for more than 6 weeks with onset of scrotal induration [4].

Prevention

Practicing safe sex can help prevent contracting sexually transmitted infections that would also help in developing epididymitis. It is also necessary to receive an appropriate diagnosis and prompt treatment for epididymitis to prevent the onset of debilitating complications [10].

Summary

Epididymitis is caused by bacterial infections and sexually transmitted diseases. Epididymis should not be confused with testicular torsion which is a urologic emergency [1]. It has been observed that epididymitis is a major and the most frequent cause of acute scrotal pain amongst the male population. The condition can be both acute and chronic in nature requiring prompt diagnosis and treatment.

Patient Information

Definition

Epididymitis is characterized by inflammation of the epididymis due to bacterial infections or structural abnormalities. It can strike males of any age and mainly occurs in those who are sexually active. Epididymmitis is considered to be the 5th most common cause of urologic emergency.

Cause

Bacterial infections, sexually transmitted infections and structural abnormalities are the major causes of epididymitis. In addition, trauma to the groin can also predispose an individual to develop such a condition. Certain medications can also cause development of epididymitis.

Symptoms

Symptoms of epididymitis include swollen scrotum that is painful and warm and tender to touch. In addition, individuals would also experience painful urination, discharge from penis, painful intercourse, blood in semen and fever.

Diagnosis

Diagnosis of epididymitis includes preliminary physical examination to check for signs of enlarged lymph nodes in the groin region. In addition, color Doppler along with ultrasound would be carried out to rule out the condition of testicular torsion.

Treatment

Treatment is done through antibiotics to ward off the infection. If the condition has occurred due to sexually transmitted infections, then partner would also require treatment. Surgery is method of choice when there is formation of abscess.

References

Article

  1. Petrack EM, Hafeez W. Testicular torsion versus epididymitis: a diagnostic challenge. Pediatr Emerg Care 1992; 8:347.
  2. Viswaroop BS, Kekre N, Gopalakrishnan G. Isolated tuberculous epididymitis: a review of forty cases. J Postgrad Med. Apr-Jun 2005;51(2):109-11, discussion 111.
  3. Trei JS, Canas LC, Gould PL. Reproductive tract complications associated with Chlamydia trachomatis infection in US Air Force males within 4 years of testing. Sex Transm Dis. Sep 2008;35(9):827-33.
  4. Kadish HA, Bolte RG. A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages. Pediatrics 1998; 102:73.
  5. Siu W, Ohl DA, Schuster TG. Long-term follow-up after epididymectomy for chronic epididymal pain.Urology. Aug 2007;70(2):333-5; discussion 335-6.
  6. Trojian TH, Lishnak TS, Heiman D. Epididymitis and orchitis: an overview. Am Fam Physician 2009; 79:583.
  7. Rizvi SA, Ahmad I, Siddiqui MA, Zaheer S, Ahmad K. Role of color Doppler ultrasonography in evaluation of scrotal swellings: pattern of disease in 120 patients with review of literature. Urol J. 2011;8(1):60-5.
  8. Wilbert DM, Schaerfe CW, Stern WD, et al. Evaluation of the acute scrotum by color-coded Doppler ultrasonography. J Urol 1993; 149:1475.
  9. Lee JY, Lee TY, Park HY, Choi HY, Yoo TK, Moon HS. Efficacy of epididymectomy in treatment of chronic epididymal pain: a comparison of patients with and without a history of vasectomy. Urology. Jan 2011;77(1):177-82.
  10. Likitnukul S, McCracken GH Jr, Nelson JD, Votteler TP. Epididymitis in children and adolescents. A 20-year retrospective study. Am J Dis Child 1987; 141:41. 

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Last updated: 2019-07-11 22:19