Epididymits

Epididymitis, infection of the epididymis (the cord­like excretory duct of the testis) is one of the most common infections of the male reproductive tract. It usually affects adults and is rare before puberty.

Causes

In youth, the infection can be due to sexually transmitted infection from chlamydia or gonorrhea and is associated with urethritis. In older men over 40, it is associated with urinary tract infections and prostatitis.

Signs and Symptoms

The symptoms of epididymitis include:

• Slight fever
• Chills
• A sensation of heaviness in the affected testicle
• The testicle becomes sensitive to touch or pressure
• Enlargement of the testicle
• Abdominal pain
• Pelvic pain
• Frequent urge to urinate
• A burning sensation on urination
• Discharge from the penis
• Blood in the urine
• Painful ejaculation.

Diagnostic tests

Urinalysis shows increased white blood cell (WBC) count, which indicates infection. Urine culture and sensitivity test findings may identify the causative organism.

A serum WBC count of more than 10,000/µl indicates infection. If orchitis also is present, the diagnosis must be made cautiously because symptoms mimic those of testicular torsion, a condition that requires urgent surgical intervention.

Treatment

The goal of therapy is to reduce pain and swelling and combat infection. It must begin immediately, especially in bilateral epididymitis, because sterility is always a threat.

During the acute phase, treatment consists of bed rest, scrotal elevation with towel rolls or adhesive strapping, broad-spectrum antibiotics, and analgesics. An ice bag applied to the area may reduce swelling and relieve pain (heat is contraindicated because it may damage germinal cells, which are viable only at or below normal body temperature). When pain and swelling subside and permit walking, an athletic supporter may prevent pain. Corticosteroids may be prescribed to help counteract inflammation, but their use is controversial.

When epididymitis is refractory to antibiotic therapy, epididymectomy under local anesthesia is necessary.

In an older patient undergoing prostatectomy, bilateral vasectomy may be necessary to prevent epididymitis as a postoperative complication, but antibiotics alone may prevent it.

Prevention

The following steps can help decrease your risk of epididymitis:

• Practice safe sex and protect yourself from sexually transmitted diseases by using condoms.
• Empty your bladder as needed; do not “hold” urine for long periods of time.