Epididymitis is an infection or inflammation of the epididymis, a tubular structure where sperm matures before ejaculation. This condition can occur in people of all ages but is most common between ages 20 and 40. The age of the person can influence the cause of the infection, although this is not always the case.

Epididymitis usually improves after treatment and resolves in less than six weeks, but in some cases, it can become a chronic condition.

Causes in Sexually Mature People

In mid-aged people, most cases of epididymitis result from a bacterial infection. In the elderly, most cases are due to backflow of urine and are caused by E. coli or bacteria found in the GI tract.

For younger sexually mature people, sexually transmitted disease is the most likely cause. About half of all cases in males less than 39 years old are from chlamydia and gonorrhea.

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Causes in People Before Sexual Maturity

In younger people, epididymitis is often caused by other factors. The most common cause is inflammation from trauma or repetitive activities, like sports that involve a lot of jumping or running.

That said, doctors should not overlook the possibility that a pre-pubescent person developed epididymitis from a sexually transmitted disease following sexual abuse.

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Early symptoms of epididymitis include chills, low fever, and a feeling of heaviness in the testicle. As the condition progresses, the testicle will become more and more painful.

More advanced symptoms may include blood in the sperm, a lump near the testicle, penile discharge, or abdominal discomfort.

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Risk Factors

In sexually mature people, sexually transmitted infections (STIs) are the most common risk factor for epididymitis, so anything that increases the risk for an STI also increases the risk for epididymitis, including anal sex, sex with a partner who has an STI, sex without using a condom, or a having a history of STIs.

In cases that are not related to STIs, the most common risk factors for epididymitis include:

  • urinary tract and prostate infections
  • an enlarged prostate
  • being uncircumcised
  • a medical procedure that affects the urinary tract
  • a weakened immune system

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Often, the first step in diagnosing epididymitis is a urinalysis to identify any acute infections or inflammatory conditions in the urine. If the doctor suspects an STI, they may obtain a culture from the tip of the penis to identify the bacteria causing it.

Depending on the extent of the infection, the doctor may use an ultrasound to determine if the blood supply to the testes is compromised. A CT scan can identify any problems in the bladder or kidneys.

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Testicular Torsion

Epididymitis has a lot of symptoms that overlap with testicular torsion, and the doctor may want to rule this out as a possibility. Testicular torsion is a medical emergency that occurs when the testicle twists, cutting off blood flow and eventually leading to necrosis.

This condition can be reversed if treated within eight hours, which is why many doctors will rule it out as a cause for epididymitis symptoms. Again, many of the symptoms overlap, but symptoms of epididymitis tend to come on slowly, while signs of torsion are generally more sudden.

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Treatment for epididymitis typically includes antibiotics if the condition is caused by bacteria. In the case of an STI, the patient's sexual partners should also be informed and treated.

Some symptoms should resolve a few days after starting antibiotics, but it can take weeks for the pain and swelling to go away completely. Comfort measures, like ice packs, pain medication, and rest, can help alleviate some discomfort. If the infection has turned into an abscess, surgery may be necessary to drain the area.

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Most cases of epididymitis are treated on an outpatient basis, but follow-up evaluations are necessary within one week of treatment to ensure the condition is responding appropriately.

Children younger than 14 may be referred to a urologist to rule out any anatomical abnormalities, and men older than 50 should be evaluated for an enlarged prostate.

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Complications can occur if epididymitits is not treated properly. These can include the formation of an abscess or the progression of the infection to the testicle. In severe cases, the infection may spread to the blood and cause sepsis, which requires emergency care.

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The best way to prevent epididmyitis is to practice safe sex. Use condoms and avoid having multiple sexual partners to prevent the spread of STIs. Prompt treatment and complying with any follow-up care are also essential for preventing complications.

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