Epididymoorchitis (patient information)
Epididymitis On the Web
For the WikiDoc page for this topic, click here
Epididymoorchitis is swelling (inflammation) of one or both of the testicles and the epididymis, the tube that connects the testicle with the vas deferens. It may occur as an isolated epididymitis, or an isolated orchitis. However, most often they occur together as epididymoorchitis.
What are the symptoms of Epididymoorchitis?
Epididymoorchitis may begin with a low-grade fever, chills, and a heavy sensation in the testicle area. The area becomes more and more sensitive to pressure.
- Blood in the semen
- Discharge from penis
- Groin pain
- Pain with intercourse or ejaculation
- Pain with urination (dysuria)
- Scrotal swelling
- Tender, swollen groin area on affected side
- Tender, swollen, heavy feeling in the testicle
- Testicle pain that is made worse by a bowel movement or straining
What causes Epididmyoorchitis?
Isolated epididymitis is usually caused by the spread of a bacterial infection from the urethra or the bladder. The most common infections that cause this condition in young heterosexual men are gonorrhea and chlamydia. In children and older men,E. coli and similar infections are much more common. This is also true in homosexual men.
The most common virus that causes isolated orchitis is mumps. It most often occurs in boys after puberty. Orchitis usually develops 4 - 6 days after the mumps begins. Because of childhood vaccinations, mumps is now rare in the United States. Orchitis may also occur along with infections of the prostate or epididymis.
Epididymoorchitis is often spread of infection from isolated orchitis or isolated epididymitis and may be caused by sexually transmitted diseases (STD), such as gonorrhea or chlamydia. The rate of sexually transmitted orchitis or epididymitis is higher in men ages 19 - 35. It is a major cause of hospital admissions in the miltary.
Who is at highest risk?
Risk factors for sexually transmitted epididymoorchitis include:
- High-risk sexual behaviors
- Multiple sexual partners
- Personal history of gonorrhea or another STD
- Sexual partner with a diagnosed STD
Risk factors for epididymoorchitis not due to an STD include:
- Being older than age 45
- Long-term use of a Foley catheter
- Not being vaccinated against the mumps
- Structural abnormalities of the urinary tract that occurred at birth (congenital)
- Regular urinary tract infections
- Surgery of the urinary tract (genitourinary surgery)
When to seek urgent medical care?
All testicle abnormalities should be medically evaluated. Call the local emergency number (such as 911) or go to the nearest emergency room if you experience sudden pain in the testicle.
Physical examination may show:
- Enlarged or tender prostate gland
- Tender and enlarged lymph nodes in the groin (inguinal) area on the affected side
- Red, tender and enlarged testicle or mass on the affected side of the scrotum
Tests may include:
- Complete blood count (CBC)
- Testicular ultrasound
- Tests to screen for chlamydia and gonorrhea (urethral smear)
- Urine culture (clean catch) -- may need several samples, including initial stream, midstream, and after prostate massage
It is important to distinguish this condition from testicular torsion. Testicular torsion is an emergency and should be treated with surgery as soon as possible.
Your health care provider will prescribe medications to treat the infection. Sexually-transmitted infections require specific antibiotics. Your sexual partners should also be treated.Treatments may include:
- Antibiotics- if the infection is caused by bacteria (in the case of gonorrhea or chlamydia, sexual partners must also be treated)
- Anti-inflammatory medications
- Pain medications
- Bed rest with the scrotum elevated and ice packs applied to the area\
Where to find medical care for Epididymoorchitis?
What to expect (Outlook/Prognosis)?
Getting the right diagnosis and treatment for epididymoorchitis caused by bacteria can usually preserve the normal testicle function.
If the testicle does not completely return to normal after treatment, further testing to rule out testicular cancer should be done. If not treated, or in some other cases, the condition can become long-term (chronic). In chronic cases, there is usually no swelling, but there is pain.
Mumps orchitis cannot be treated, and the outcome can vary. Men who have had mumps orchitis can become sterile.
Some boys who develop isolated orchitis caused by mumps will have shrinking of the testicles (testicular atrophy). Orchitis may also cause infertility and very often spreads to involve the epididymis.
Other potential complications include:
- Abscess in the scrotum
- Chronic epididymitis
- Death of testicle tissue (testicular infarction)
- Fistula on the skin of the scrotum (cutaneous scrotal fistula)
- Scrotal abscess
- Acute pain in the scrotum or testicles can be caused by twisting of the testicular blood vessels (torsion), which is a surgical emergency. If you have sudden pain in the scrotum or testicles, get immediate medical attention.
Getting vaccinated against mumps will prevent mumps-associated orchitis. You can prevent complications from isolated bacterial orchitis and epididymitis by getting diagnosed early, and by treating the underlying infections.
Safer sex behaviors, such as having only one partner at a time (monogamy) and condom use, will decrease the chance of developing epididymoorchitis as a result of a sexually transmitted disease.