Epididymitis And Orchitis

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Epididymitis And Orchitis

What Is It?

Epididymitis is a swelling (inflammation) of the epididymis, the coiled tube located at the back of the testicle. In most cases, an infection causes this inflammation. The infection spreads to the epididymis from the organs and ducts involved with urination and reproduction.

Orchitis is an infection of the testicle. It is much less common than epididymitis. Orchitis usually spreads to the testicle through the bloodstream. Viruses commonly cause the infection. About 20 percent of males over age 14 who have the mumps get orchitis.

When epididymitis spreads to the testicle, the condition is called epididymo-orchitis, which is an inflammation of both the epididymis and the testicle.

Infections that cause epididymitis usually are related to age, medical history and sexual activity:

• Before puberty – Intestinal bacteria, such as E. coli, most often cause epididymitis, when they travel from an infection in the bladder or some other site in the urinary tract. In many cases, a birth-related abnormality affects the urinary tract's structure or function. For example, a boy may be born with a structural abnormality involving the tube that carries urine through the penis, or the tube that carries urine from the kidney to the bladder. These abnormalities increase the boy's risk of urinary tract infections, which eventually spread to the epididymis.

• In sexually active men – The most common cause of epididymitis is a sexually transmitted disease (STD), usually Chlamydia, gonorrhea or both. Although the initial site of infection is the tube-like passageway (urethra) that carries urine and semen out of the penis, eventually bacteria spread backward through the reproductive tract to attack the epididymis. It may take several months after the sexual encounter that causes the STD for epididymitis to appear. In some cases, the man first has symptoms of an infected urethra, such as an abnormal discharge from the penis or a burning sensation when urinating. In other cases, symptoms of epididymitis are the first and only signs of an STD. Among men who have anal intercourse, epididymitis usually is caused by intestinal bacteria from the anus. These bacteria enter the urethra through the penis, and then travel backward through the reproductive tract to the epididymis.

• In adults with a high-risk medical history – In men with a history of urinary tract infections or prostate infections, epididymitis usually is caused by intestinal bacteria that have spread from the infected site. This is the most common form of epididymitis in men over age 40.

• After surgery, testing or catheterization – Epididymitis may develop after surgery or a diagnostic test that involves the bladder or urethra, or after a catheter has been inserted to collect urine. In these cases, the infection usually is caused by intestinal bacteria that have entered the urethra or bladder, either during the procedure or through the catheter.

• Other forms (all age groups) – Rarely, epididymitis can occur when a systemic (whole body) infection spreads through the bloodstream and moves to the epididymis. Also, a noninfectious form of epididymitis can develop in men who take amiodarone (Cordarone, Pacerone), a heart medication that seems to build up in the epididymis. Some cases have been blamed on intense exercise, especially heavy lifting. The strain of heavy lifting may force urine from the bladder into the epididymis, where it causes a form of chemical irritation that triggers epididymitis.

• Of unknown origin – Noninfectious epididymitis (epididymitis with no medical evidence of an infection) is fairly common, but its cause is not clear.

Epididymitis accounts for more than 600,000 office visits to U.S. doctors each year, and is a major cause of sick days among working men. Although many cases of epididymitis can be treated at home, some are so severe that hospitalization is necessary. In U.S. hospitals, about 20 percent of all men under age 35 admitted for urological illnesses are diagnosed with epididymitis.

Symptoms

Symptoms of epididymitis and orchitis can include:

• Pain, swelling and tenderness in your scrotum, with only one side of the scrotum affected (about 90 percent of cases)

• Pain that at first is most intense at the back of one testicle but within a few hours spreads to the entire testicle, the overlying scrotum and, in some cases, the groin

• Inability to walk without limping because of pain

• Redness and heat in the painful area

• Burning when you urinate

• An accumulation of watery fluid in the scrotum

• Fever, chills and a burning sensation during urination

• A clear, white or yellow abnormal discharge similar to puss from the tip of your penis that may leave a stain on your underwear – this occurs in some men with STDs.

Diagnosis

After you describe your symptoms, your doctor will ask questions about your medical history, surgical history and sexual activity. He or she then will examine you, and will look at your genital area. You may need one or more of the following tests:

• Urinalysis, a chemical analysis of urine

• Urine cultures, which determine whether bacteria are present in the urine, indicating a possible urinary tract infection

• Laboratory testing of fluid taken from inside the urethra

• Laboratory tests on a sample of any discharge from the penis

• Blood tests to check for signs of infection, including STDs

In some cases, symptoms of epididymitis are so severe that the doctor must test to see if you have testicular torsion, a sudden, painful twisting of the testicle that cuts off the testicle's blood supply. You may need an ultrasound, a painless test that uses sound waves, in this case to measure blood flow in the testicles. Radionuclide scanning is another test you may need. In this test, a small amount of a radioactive isotope is injected into your blood. If the isotope collects near the testicle, it may indicate testicular torsion.

Expected Duration

In most cases of mild bacterial epididymitis, pain decreases within one to three days after you start taking antibiotics. However, swelling in the scrotum and testicle may last for several weeks or months.

Prevention

To help reduce your risk of epididymitis caused by STDs, follow these guidelines for safer sex:

• Don't have sex.

• Have sex with only one, uninfected partner.

• Use latex or polyurethane condoms during every sexual activity, including oral and anal sex.

Treatment

Antibiotics treat epididymitis caused by infection:

• Epididymitis caused by STDs – A variety of antibiotics work against chlamydia and gonorrhea, the most common causes of epididymitis related to STDs. To prevent the spread of these diseases, all your sex partners must receive antibiotics as well.

• Epididymitis caused by intestinal bacteria – A variety of antibiotics work against this type of infection.

A young boy with epididymitis probably will be referred to a urologist (a doctor who specializes in illnesses of the urinary tract and male reproductive organs) to check for urinary tract problems.

If you are being treated for epididymitis, your doctor may suggest that you try the following measures to relieve discomfort and help healing:

• Rest in bed for a day or two.

• Elevate your scrotum with a towel.

• Apply ice packs to the painful area.

• Drink plenty of fluids, especially water.

• Take a nonsteroidal anti-inflammatory drug, such as ibuprofen (Advil, Motrin and others) or naproxen (Aleve, Naprosyn and others), to relieve pain and inflammation.

People with severe pain in the scrotum may need a stronger pain medication, such as acetaminophen (Tylenol) with codeine. If this is not effective, the doctor may inject anesthetic medication directly into the painful area.

When To Call a Professional

A doctor must evaluate severe pain in the scrotum or testicles because it can be a symptom of testicular torsion, as well as epididymitis. Call your doctor immediately if you develop pain, tenderness or swelling in your scrotum, especially if these symptoms develop rapidly over a few hours.

Also, contact your doctor if you notice an abnormal discharge from your penis or burning when you urinate.

Prognosis

With treatment, most cases of mild epididymitis and orchitis can be cured. There is usually no long-term effect on fertility, especially when only one side of the scrotum is involved.

Additional Info

National Institute of Diabetes & Digestive & Kidney Disorders Office of Communications and Public Liaison Building 31, Room 9A04 31 Center Drive, MSC 2560 Bethesda, MD 20892-2560 Phone: 301-496-4000 http://www.niddk.nih.gov/

American Urological Association 1000 Corporate Blvd. Linthicum, MD 21090 Phone: 410-689-3700 Toll-Free: 1-866-746-4282 Fax: 410-689-3800 http://www.urologyhealth.org/

American Academy of Family Physicians (AAFP) 11400 Tomahawk Creek Parkway Leawood, KS 66211-2672 Phone: 913-906-6000 Toll-Free: 1-800-274-2237 http://www.familydoctor.org/

Centers for Disease Control and Prevention (CDC) 1600 Clifton Road Atlanta, GA 30333 Phone: 404-639-3534 Toll-Free: 1-800-311-3435 http://www.cdc.gov/

Last updated:	December 20, 2007