The epididymis is a coiled tube located at the back of each testis, responsible for storing sperm until they mature and then transporting them to the vas deferens. This tube carries sperm from the epididymis to the urethra.
Epididymitis is a condition in which an inflammatory process usually secondary to infection results in painful swelling of the epididymis. It is the 5th most common urological condition in males, and most cases follow either a sexually transmitted infection (STI) of gonorrhea and chlamydia or a Urinary Tract Infection (UTI). Although it can occur at any age, adults aged between 20 to 40 years are more often affected.
Depending on how long symptoms persist, the condition can be labeled as either acute or chronic – less than 6 weeks for acute epididymitis and more than 6 weeks for chronic epididymitis. There may also be concurrent inflammation of the testis, which is known as Epididymo-orchitis.
WHAT ARE THE SYMPTOMS OF EPIDIDYMITIS?
A person with epididymitis can experience nonspecific symptoms such as a low-grade fever with chills and pain in the pelvic region. More specific symptoms such as pain and tenderness of the testicles and warmth and redness of the scrotum are usually present and, in many cases, are the only presenting symptom. Since most cases will usually follow a sexually transmitted infection (STI) such as gonorrhea and chlamydia, there can be complaints of an abnormal penile discharge along with enlargement of lymph nodes present in the groin. Painful sexual intercourse –dyspareunia, Painful urination –dysuria, and the presence of blood in semen –hematospermia are other less reported complaints.
The pain in acute epididymitis is more severe and generally not just limited to the scrotum compared to chronic epididymitis, which has a pain of intermittent nature. Another differentiating besides the duration of pain for which the pain has existed is that the skin of the scrotum is not usually swollen, tender, red, or warm in chronic epididymitis.
Epididymitis symptoms are quite similar to another condition known as testicular torsion. It happens when the spermatic cord twists, cutting off blood supply to the testis. Since the loss of blood supply can result in the testis dying, this is a medical emergency. So the symptoms have to be differentiated to rule out the possibility of testicular torsion. Your doctor will be able to do this by performing a physical examination and trying to elicit what is known as Prehn’s sign.
A positive Prehn’s sign is associated with epididymitis and involves assessing consequent pain changes when the scrotum is lifted. If the pain relieves after lifting the scrotum, epididymitis is the likely diagnosis.
HOW IS EPIDIDYMITIS DIAGNOSED?
Epididymitis diagnosis will involve a series of steps by your health care provider, including starting with a detailed history, followed by a physical examination and certain investigations that will help establish the diagnosis.
You will be asked to provide a detailed history and your sexual history, which will help assess your risk for having contracted an STI. It is important to remain honest during this discussion.
The physical examination will involve a general physical examination, an examination of the genitalia, and sometimes, a rectal examination to check for any tenderness of the prostate gland. One way a doctor assesses if epididymitis is present is by assessing the Prehn sign. When there is a relief of pain when the testicle is raised, this is a positive Prehn’s sign and is concurrent with epididymitis diagnosis. As discussed previously, a positive Prehn’s sign may be noted on examination and help to establish a provisional diagnosis of epididymitis.
If the examination suggests epididymitis, certain investigations can then be performed to confirm the provisional diagnosis and rule out other differentials. These will include taking a urine sample, blood sample, and swab sample of penile discharge –if present- to test for Sexually Transmitted Diseases (STDs) and Urinary Tract Infections (UTIs). Ultrasound is a non-invasive test that uses sound waves to produce a detailed image of your scrotum and testes and can detect any abnormalities that might be present in the area. They are also useful in measuring the blood flow in the epididymis.
HOW IS EPIDIDYMITIS TREATED?
Antibiotics are the mainstay for the treatment of epididymitis caused by bacteria. They are prescribed over a short course lasting 1 to 2 weeks and the ones commonly used include doxycycline, ciprofloxacin, levofloxacin, and trimethoprim-sulfamethoxazole. Most cases are treatable at home with the prescribed antibiotics taken orally. Cases where the infection is severe, a high fever is present, or the pain is severe and not controlled may require a short stay at the hospital.
Anti-inflammatory medications such as Naproxen and Ibuprofen can be prescribed alongside antibiotics and help relieve pain and ease the swelling. For cases with severe pain, a short-term narcotic can be used.
Tuberculous Epididymitis, which is sometimes the only manifestation of genitourinary tuberculosis, is treated through the use of anti-tuberculous drugs such as isoniazid, rifampicin, and ethambutol. Severe tuberculous infections may cause a lot of damage and ultimately require surgery to remove the testis and epididymis, a procedure known as orchiectomy.
Non-infectious causes of epididymitis have no set treatment. If epididymitis is a result of using the Calcium channel blocker, Amiodarone, the use of the drug has to be stopped and suitably replaced.
Other measures such as elevating the scrotum and applying cold compresses to the affected area are effective in relieving swelling.
WHAT ARE THE COMPLICATIONS OF EPIDIDYMITIS?
Early diagnosis and with the right treatment, epididymitis usually resolves without any major long-term complications Symptoms begin to improve within a few days of starting antibiotics. However, discomfort and swelling can persist for a few weeks or months. If not properly treated, the condition can turn chronic, pus can collect in the scrotum and form an abscess, or the skin of the scrotum can open up because of swelling.
Severe cases in which the inflammatory process has resulted in a lot of damage require surgery to remove the testis and epididymis – orchiectomy-.
Fertility problems are a rare complication.
HOW CAN EPIDIDYMITIS BE PREVENTED?
Epididymitis can be prevented by practicing safe sex and knowing your STD status. Refraining from unprotected intercourse, not engaging in homosexual intercourse, avoiding having multiple sexual partners, and refraining from drugs that could potentially lead to unsafe sexual practices, are all measures that mitigate the risk of contracting a Sexually Transmitted Disease (STD) and so, in turn developing epididymitis.
Minimizing long periods of sitting and avoiding strenuous weight lifting also reduces the risk of developing epididymitis.