What is Acute Epididymitis

Written by Kimberly Vaughn, MD

Sunday, 04 October 2009

Epididymitis is an infection of the epididymis. The epididymis is a soft, coiled tubular structure on the back of the testicle. What is going on in the body? Infections generally spread to the epididymis from the bladder or the urethra. The urethra is the tube that allows urine to pass from the bladder to the outside of the body. In young children or older men, bacteria that cause urinary tract infections are often the cause. Sexually transmitted diseases are more likely to be the cause in sexually active young men. Infection in the epididymis causes severe pain and swelling. The infection may spread to the testicle. When both structures are inflamed, the condition is known as epididymo-orchitis. It is rare that an infection will occur in the testicle alone. The bacteria will usually infect the epididymis first. What are the causes and risks of the disease? Risk factors for epididymitis are the same as for infections of the urethra or bladder. These two conditions create an increased risk for epididymitis. Infections of the urethra are often sexually transmitted. These infections may be avoided by not having sex or using condoms during sex. Bladder infections are more common in those with inherited kidney and bladder problems. Bladder infections are also more common in those with enlarged prostate glands. Persons who need to use urinary catheters are at a higher risk for epididymitis. Urinary catheters are urine drainage tubes placed through the penis into the bladder. What are the treatments for the disease? Epididymitis is generally treated with 4 to 6 weeks of oral antibiotics. Hospitalization and intravenous antibiotics may be needed for severe infections. It is important to treat an affected person's sexual partners after a sexually transmitted disease. This prevents a repeat infection. If examination and x-ray tests cannot rule out testicular torsion, surgery may be necessary. Untreated testicular torsion may lead to destruction of the affected testicle. What are the side effects of the treatments? Medications used to treat this problem may cause: - allergic reaction - stomach upset - skin sensitivity to sunlight If surgery is required, there is a risk of bleeding and infection, as with all surgeries. What happens after treatment for the disease? A person may have a relapse if the course of medication is not long enough. In these cases, 6 weeks of medication may be needed. Sometimes, persons will need another 8 to 12 weeks of antibiotics after that. How is the disease monitored? Even if treated adequately, epididymitis can recur. Surgery to remove the epididymitis or the testicle may be needed if: - an episode does not respond to antibiotics - an abscess or pocket of pus develops