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.
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
Entire Body System
Regarding the relationship between urine findings and EP-related symptoms, pyuria was significantly related to fever (37℃ or higher; p=0.0159). [ncbi.nlm.nih.gov]
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]
Rest in bed for the first few days until the fever, pain, and swelling get better. It may take several weeks for all of the swelling to go away. Constipation can make you strain. This makes the pain worse. [fairview.org]
Patient usually presents with epididymal tenderness and swelling, scrotal swelling and redness, fever and possibly urethral discharge. [rxmed.com]
- 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]
- Swelling of the Scrotum
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]
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]
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]
Pain, tenderness, and swelling in the scrotum (epididymides or testicles) that gradually get worse are the most common symptoms of epididymitis. [uwhealth.org]
- Testicular Swelling
Scrotal pathologic changes in general and testicular swellings particularly offer an open challenge to the medical profession. [jamanetwork.com]
Age at presentation and likelihood of testicular swelling or hydrocele was not different between children with and without UTAs. [ncbi.nlm.nih.gov]
swelling and tenderness; normal cremasteric reflex; pain relief with testicular elevation (Prehn sign) Enlarged, thickened epididymis with increased blood flow on color Doppler Orchitis Abrupt onset of testicular pain Testicular swelling and tenderness [aafp.org]
Patients would not likely see as much testicular inflammation with a type of UTI. It is essential to see your physician immediately if you have any symptoms of pain during urination or testicular swelling. [msurology.com]
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  .
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 .
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 .
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 .
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 .
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 .
Epididymitis is caused by bacterial infections and sexually transmitted diseases. Epididymis should not be confused with testicular torsion which is a urologic emergency . 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.
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.
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 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 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 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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