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Epididymitis Orchitis

Epididymitis is inflammation of the epididymis—the coiled tube attached to the back and upper side of the testicle that stores sperm and passes it on to the vas deferens. There are two forms of this condition, acute and chronic. Acute epididymitis comes on suddenly with severe symptoms that subside with treatment. Chronic epididymitis tends to develop more slowly, over longer periods of time, for which the symptoms can improve with treatment, but may not completely resolve. Orchitis is inflammation of the testicle, typically with a sudden onset. When both the epididymis and testicle get inflamed, the condition is called epididymo-orchitis. 

SYMPTOMS:

In acute infectious conditions you may experience:

  • Pain, swelling, tenderness, and redness of the scrotum (the sac of tissue that hangs below the penis and holds the testicle).
  • Firmness and warmth of the scrotal skin.
  • Fevers, urethral discharge, urinary frequency and/or urgency, painful/burning urination. 

In the chronic setting, you may experience:

  • Pain or discomfort only in the scrotum, less severe and more localized than acute epididymitis.
  • Swelling, tenderness, redness and warmth of the skin do not occur.

RISK FACTORS:

  • Being a male. Women do not have epididymis or testis.
  • Sexually active men (typically under 40 years of age) with exposure to sexually transmitted diseases that cause infection of the epididymis, such as gonorrhea or chlamydia. These infections can move from the urethra into the testicle.
  • Urinary tract infections (UTI) -  An illness caused by harmful bacteria, viruses or yeast growing in the urinary tract.  This can be due to blockage of the bladder from prostate enlargement or prostatitis (inflammation of the prostate), scarring of the urethra, or bladder infections due to catherization or instrumentation of the urethra. These are the most common causes in men over 40.
  • Trauma/injury
  • Mumps
  • Prostatitis
  • Sometimes there is no known cause

EVALUATION AND DIAGNOSTIC TESTING:

  • Thorough history and physical exam
  • Urinalysis (collection of urine) to check for infection
  • A swab of the urethra (a tube that carries urine from the bladder to the outside of the body) to check for sexually transmitted infection
  • Ultrasound of the scrotum to make sure the testicles do not have tumor or are not twisted

TREATMENT:

The treatment would depend on the cause. Antibiotics (medicine that fights infection) or anti-inflammatory medications may be prescribed. Warm soaks and/ or icepacks, and scrotal support may be used to treat epididymitis /orchitis. Complete resolution of your symptoms may take some time, but you should notice improvement within a few days after starting treatment. The pain or discomfort can continue until the full course of antibiotics is complete, but the firmness and swelling may take months to resolve.