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].

• Inflammation

  In the latter form, the pain and inflammation of the epididymis can continue for more than 6 weeks with onset of scrotal induration. [symptoma.com]

  Avoid very hot compresses to soothe the inflammation; they can damage the sperm-making tubes. Application of ice bags may reduce pain. [healthcentral.com]

  The condition is referred to as acute epididymo-orchitis if concurrent inflammation of the testis is present. The acute presentation of epididymitis will be covered. [bestpractice.bmj.com]

  Some men develop chronic epididymitis, which is inflammation even when there is no infection. [betterhealth.vic.gov.au]

• Swelling

  In acute epididymitis, symptoms are present for less then six weeks and are characterized by pain and swelling. Chronic epididymitis is characterized by pain, generally without swelling, that persists for more than three months. [aafp.org]

  Inflammation of the epididymis causing pain and swelling, which is usually unilateral and develops over the course of a few days. In sexually active men (aged Chlamydia trachomatis or Neisseria gonorrhoeae. [bestpractice.bmj.com]

  Swelling with mild discomfort—Conditions that cause swelling in the scrotal area also may occasionally result in mild discomfort. These conditions include varicocele, hydrocele, and spermatocele. [neilbaum.wordpress.com]

• Fever

  Symptoms The main symptoms are fever and pain, developing progressively over several hours, in the back portion of the testicles. Symptoms include fever and chills, pain in the groin, and tender, swollen epididymes. [healthcentral.com]

  In addition, individuals would also experience painful urination, discharge from penis, painful intercourse, blood in semen and fever. [symptoma.com]

  It may be associated with irritative lower urinary tract symptoms, urethral discharge, and fever. It is usually unilateral. The condition is referred to as acute epididymo-orchitis if concurrent inflammation of the testis is present. [bestpractice.bmj.com]

  In bacterial epididymitis, patients may also have fever, nausea, or urinary symptoms. Urethral discharge may be present if the cause is urethritis. [msdmanuals.com]

• Severe Pain

  However, severe pain and redness over the patient's right hemi-scrotum were noted on the day of surgery. A repeat scrotal ultrasound was performed that revealed findings suggesting a chronic inflammatory process rather than a malignancy. [ncbi.nlm.nih.gov]

  If a hydrocele (an abnormal fluid-filled sac around the testicles) becomes infected, it can lead to epididymitis, which can cause severe pain. [neilbaum.wordpress.com]

  People with severe pain in the scrotum may need a stronger pain medication. One option is acetaminophen (Tylenol) with codeine. If this is not effective, the doctor may inject anesthetic medication directly into the painful area. [2minutemedicine.com]

  Go to the emergency room or call the local emergency number (such as 911) if you have sudden, severe testicle pain or pain after an injury. Prevention You can prevent complications if you get diagnosed and treated early. [mountsinai.org]

  Pain medicine: You may be given a prescription medicine to decrease pain. Do not wait until the pain is severe before you take this medicine. Take your medicine as directed. [drugs.com]

• Gangrene

  gangrene in atherosclerosis of native arteries of the extremities ( I70.26 ) gangrene in hernia ( K40.1, K40.4, K41.1, K41.4, K42.1, K43.1-, K44.1, K45.1, K46.1 ) gangrene in other peripheral vascular diseases ( I73.- ) gangrene of certain specified [icd10data.com]

  Fournier's gangrene is a necrotizing fasciitis of the perineum caused by a mixed infection with aerobic/anaerobic bacteria resulting from a perirectal abscess, trauma, circumcision, an insect bite, hemorrhoids, rectal biopsy, and other insults to the [cid.oxfordjournals.org]

  You're correct that it's likely not torsion, since you would have a gangrenous scrotum at this point. [letsrun.com]

• Vascular Disease

  ICD-10-CM Codes › N00-N99 Diseases of the genitourinary system › N40-N53 Diseases of male genital organs › N45- Orchitis and epididymitis › Epididymitis 2016 2017 2018 2019 Billable/Specific Code Male Dx N45.1 is a billable/specific ICD-10-CM code that [icd10data.com]

  Coronary Artery Disease or Peripheral Vascular Disease. No change in standard management. E. Diabetes or other Endocrine issues. No change in standard management. F. Malignancy. No change in standard management. G. [cancertherapyadvisor.com]

• Erythema

  Other signs and symptoms such as discharge, dysuria, frequency, urgency, erythema of the scrotal skin, and fever may be present also. [cid.oxfordjournals.org]

  Physical examination reveals swelling, induration, marked tenderness, and sometimes erythema of a portion of or all of the affected epididymis and, sometimes, the adjacent testis. [msdmanuals.com]

  Definition Epididymitis can be defined as inflammation of the epididymis manifested by a gradual onset of unilateral testicular pain (sometimes bilateral pain) and swelling often with tenderness of the epididymis and vas deferens and occasionally with erythema [canada.ca]

  Erythema and/or edema of the scrotum on the affected side. Fever. Diagnosis Footnote 5 If diagnosis is questionable, a specialist should be consulted immediately, because in the case of testicular torsion, testicular viability may be compromised. [phac-aspc.gc.ca]

  Genital ulcers and erythema nodosum lesions were more common among patients with varicocele (P = .034 and .058, respectively). [ncbi.nlm.nih.gov]

• Ulcer

  Genital ulcers and erythema nodosum lesions were more common among patients with varicocele (P = .034 and .058, respectively). [ncbi.nlm.nih.gov]

  If the edge of one eyelid turns inward (entropion), the eyelashes rub against the eye, which can lead to ulcer formation and scarring of the cornea. [msdmanuals.com]

  NSAIDs can cause stomach pain, ulcers, and rarely, kidney problems. Chronic pain may be treated with specialized pain management methods. Surgery may be needed in severe cases with complications (e.g., abscess, death of a testicle). [healthcommunities.com]

  Skin ulcer over the swelling C. Dermal Edema D. Satellite Nodule13. Which of the following is not an etiological factor for pancreatitis? A. Abdominal trauma B. Hyperlipidemia C. Islet cell hyperplasia D. [ukmall.net]

  2016) : No change 2018 (effective 10/1/2017) : No change 2019 (effective 10/1/2018) : No change Didymytis N45.1 Epididymitis (acute) (nonvenereal) (recurrent) (residual) N45.1 Gangrene, gangrenous (connective tissue) (dropsical) (dry) (moist) (skin) (ulcer [icd10data.com]

• Skin Ulcer

  10/1/2016) : No change 2018 (effective 10/1/2017) : No change 2019 (effective 10/1/2018) : No change Didymytis N45.1 Epididymitis (acute) (nonvenereal) (recurrent) (residual) N45.1 Gangrene, gangrenous (connective tissue) (dropsical) (dry) (moist) (skin [icd10data.com]

  Skin ulcer over the swelling C. Dermal Edema D. Satellite Nodule13. Which of the following is not an etiological factor for pancreatitis? A. Abdominal trauma B. Hyperlipidemia C. Islet cell hyperplasia D. [ukmall.net]

• Irritability

  It may be associated with irritative lower urinary tract symptoms, urethral discharge, and fever. It is usually unilateral. The condition is referred to as acute epididymo-orchitis if concurrent inflammation of the testis is present. [bestpractice.bmj.com]

  This case report describes a sigmoid diverticulitis with torpid development, long-term symptoms of bladder irritability, and an emphysematous epididymitis caused by a direct seminal vesicle fistula. [ncbi.nlm.nih.gov]

  A strenuous activity like weightlifting might cause urine to get caught in the epididymis and aggravate your condition by causing irritation. [livestrong.com]

• Scrotal Pain

  Testicular cancer and trauma may also cause scrotal pain. Table 1 includes the selected differential diagnosis of acute scrotal pain. 3, 13 – 15 Enlarge Print Table 1. [aafp.org]

  When to see a doctor Never ignore scrotal pain or swelling, which can be caused by a number of conditions. Some of them require immediate treatment to avoid permanent damage. If scrotal pain is severe, seek emergency treatment. [mayoclinic.org]

  Tags: epididymitis, orchitis, scrotal pain, scrotal swelling Posted in Uncategorized | 3 Comments » Pain in the Pouch- Scrotal Pain May Be Coming From Somewhere Else June 9, 2012 By far, most causes of pain in the pouch is from the testicles and the epididymis [neilbaum.wordpress.com]

  A history of intermittent scrotal pain is uncommon in epididymitis or torsion of the testicular appendages but may occur with intermittent testicular torsion. [4] Testicular cancer and trauma may also cause scrotal pain. [emedicine.com]

• Testicular Pain

  Chronic epididymitis refers to inflammation characterized by persistent testicular pain in the absence of scrotal swelling. This condition is usually more difficult to treat and may result in long-term pain. [innerbody.com]

  Epididymitis usually begins with a gradual onset of testicular pain that increases in severity over time. The testicle can become swollen, tender to touch and red. [chop.edu]

  pain and often unilateral lower abdominal pain urinary frequency or urgency urinary dysuria Physical exam fever testicular erythema, tenderness, and induration cremasteric reflex intact Prehn's sign decrease in pain with scrotal elevation Imaging Ultrasound [medbullets.com]

• Swelling of the Scrotum

  Diagnosis and Treatment In acute epididymitis, the physical examination shows tenderness and swelling of the scrotum, discharge from the penis, enlarged groin lymph nodes, and fever. [innerbody.com]

  A 19-year-old adolescent, presented to urologist with painful swelling of the scrotum on the left side over the preceding several days. Antibiotics were administered by physician for two months and the pain improved, but the swelling did not fade. [ncbi.nlm.nih.gov]

  Appears pain and swelling in the scrotum by the defeat, increased epididymis several times, redness of the skin of the scrotum men impotency. Often combined with inflammation of the testicle (orchiepididymitis). [carbohealth.com]

  Pain, tenderness, and swelling in the scrotum (epididymides or testicles) that gradually get worse are the most common symptoms of epididymitis. [healthlinkbc.ca]

  Symptoms Symptoms of epididymitis and orchitis can include: Pain, swelling and tenderness in your scrotum. Only one side of the scrotum is affected. Pain that at first is most intense at the back of one testicle. [2minutemedicine.com]

• Dysuria

  In our study, the best predictors were dysuria, a painful epididymis on palpation, and altered epididymal echogenicity and increased peritesticular perfusion found on ultrasound studies for epididymitis and a positive blue dot sign for AT. [ncbi.nlm.nih.gov]

  […] of pathogen bladder outlet obstruction bacteriuria and subsequent retrograde ascent of pathogen Prognosis resolves with antibiotics Presentation Symptoms testicular pain and often unilateral lower abdominal pain urinary frequency or urgency urinary dysuria [medbullets.com]

  Clinical diagnosis may be reinforced by detection of urethritis on gram stain chlamydia and gonorrhoea nucleic acid amplification testing and urine microscopy and culture Common symptoms Scrotal pain, swelling and erythema occasionally associated with dysuria [contacttracing.ashm.org.au]

• Enlargement of the Prostate

  And in older men it is often caused by enlargement of the prostate gland. Bacterial infections, possibly spread from the rectal area or following a urological procedure, also may cause epididymitis. And an injury to the groin may cause epididymitis. [healthlinkbc.ca]

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].

• Pyuria

  In the multivariate analysis, older age (65 years or older) was significantly correlated with the presence of pyuria (p=0.0156). [ncbi.nlm.nih.gov]

  Its clinical features include enlarged epididymis, a swollen SCROTUM; PAIN; PYURIA; and FEVER. [online-medical-dictionary.org]

• Chlamydia

  the Centers for Disease Control and Prevention recommends beginning treatment before all laboratory test results are available, and basing therapy choice on the risk of chlamydia and gonorrhea or enteric organisms. 1 In settings where gonorrhea or chlamydia [aafp.org]

  The treatment of choice is often azithromycin and cefixime to cover both gonorrhoeae and chlamydia. [en.wikipedia.org]

  In men < 35 years, most cases are due to a sexually transmitted pathogen, especially Neisseria gonorrhoeae or Chlamydia trachomatis. Infection may begin as urethritis. [msdmanuals.com]

  Usually, the treatment of choice for both gonorrhea and chlamydia are azithromycin or ceftriaxone plus doxycycline can be used. [kenhub.com]

  In sexually active men aged 14–35 years and in older men who have sex with men, Neisseria gonorrhoeae and Chlamydia trachomatis are the most common organisms. [cid.oxfordjournals.org]

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].

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].

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].

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].

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].

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].

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.

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.

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