Epididymitis

What is epididymitis?

Epididymitis (up-uh-DID-uh-MI-tis) is inflammation of your epididymis (ep-uh-DID-uh-miss) that causes discomfort or pain in your scrotum, testicle or epididymis. Your epididymis is a coiled tube at the back of your testicle — most people have one behind each testicle (plural epididymides). It stores and carries sperm.

Inflammation anywhere in your body can be painful and uncomfortable. It can be even more distressing when it affects a sensitive area. But inflammation is your body’s way of telling you that something’s wrong, and you should talk to a healthcare provider. They’ll do their best to identify what’s causing your pain, treat you promptly and put your mind at ease.

What are the types of epididymitis?

There are two general types of epididymitis:

• Acute (sudden) epididymitis. This is when your symptoms develop suddenly and get worse. Acute epididymitis is usually the result of a bacterial infection.
• Chronic (long-lasting) epididymitis. This is when you have discomfort or pain for six weeks or longer. The discomfort or pain may go away and come back. The symptoms are usually less severe than acute epididymitis.

How common is epididymitis?

There are about 600,000 cases of epididymitis in the United States each year.

What are the symptoms of epididymitis?

Epididymitis symptoms may include:

• Pain in your scrotum, which may move to the rest of your groin. The pain may be on one side or both sides, and may be mild or severe.
• Swollen testicles.
• Fever and chills.
• Pain when you pee (dysuria).
• Blood in your semen (hematospermia).

What is the main cause of epididymitis?

A bacterial infection is the most common cause of acute epididymitis. If you’re under 35 years of age, sexually transmitted infections (STIs) — such as gonorrhea or chlamydia — are the most common cause of epididymitis.

If you’re older than 35, the most common cause of epididymitis is the backflow of infected pee (urine) down your ejaculatory tract to the epididymis. The most common bacteria that associates with this is E. coli. Men who have sex with men also have an increased risk of epididymitis from exposure to gastrointestinal bacteria, such as E. coli.

Other infections, including the mumps virus and, rarely, tuberculosis, can also cause epididymitis.

Other less common causes of epididymis include:

• A blockage in your urethra.
• An infection in your prostate gland (prostatitis).
• Using a urinary catheter, like a Foley catheter.
• An injury to your groin.
• The arrhythmia medication amiodarone.

Can you get epididymitis without an STI?

Yes, you can get epididymitis through nonsexually transmitted infections. For example, prostate infections and UTIs can spread to your epididymis.

Is epididymitis contagious?

Yes, epididymitis can spread through sexual contact. While healthcare providers don’t categorize it as an STI, it’s still a common symptom of many STIs, including chlamydia and gonorrhea.

Who does this condition affect?

People assigned male at birth (AMAB) develop epididymitis. It can occur at any age.

What are the complications of epididymitis?

Without treatment, epididymitis can cause complications, like an abscess in your scrotum. Your scrotal skin can also open up or break because of swelling and infection.

In rare cases, epididymitis can cause male infertility problems. You can help prevent these complications by seeking treatment as soon as you notice symptoms.

How is epididymitis diagnosed?

A healthcare provider will ask you questions about your symptoms and perform a physical examination of your scrotum to look for a tender area or lump. They may also order tests, including:

• Pee test (urinalysis). They’ll look for the presence of bacteria in a sample of your pee.
• Blood tests. They’ll withdraw a sample of blood and examine it for signs of infection.
• Bacteria swab tests. They’ll insert a swab into your urethra and test the swab for STI pathogens (bacteria or viruses), which may require treatment.
• Ultrasound. In some cases, they may take images of your scrotum to help make an epididymitis diagnosis.

How is epididymitis treated?

Epididymitis treatment depends on the cause.

Bacterial epididymitis

If bacteria cause epididymitis, treatment involves antibiotics. The most common medications include:

• Doxycycline.
• Ciprofloxacin.
• Levofloxacin.
• Trimethoprim-sulfamethoxazole.

Most people need to take antibiotics for about one to two weeks. In rare cases, you may need a prolonged course of antibiotics.

Tuberculosis epididymitis

If tuberculosis causes epididymitis, a healthcare provider may prescribe:

• Isoniazid-pyrazinamide-rifampin.
• Ethambutol.
• Rifapentine.

Most people need to take antituberculosis medications for six to nine months.

In severe cases, a surgeon may need to remove one or both of your epididymides (epididymectomy) or testicles (orchiectomy).

Amiodarone epididymitis

If the arrhythmia medication amiodarone causes epididymitis, a healthcare provider may reduce your dosage or prescribe another medication. Talk to a provider before you adjust or stop taking amiodarone.

Other causes of epididymitis

Epididymitis treatment varies for non-infection causes. A healthcare provider will talk to you about how to stay comfortable.

Does epididymitis go away?

Bacteria causes most cases of epididymitis. Bacterial epididymitis cases won’t go away on their own. It’s important to talk to a healthcare provider as soon as you notice symptoms to get proper treatment and avoid further complications.

Does ejaculating help epididymitis?

Ejaculating won’t make epididymitis worse. But it can make the pain more intense for some people. You shouldn’t have sexual intercourse with anyone until a healthcare provider says it’s OK. It’s also best to avoid masturbation until you complete your treatment.

Can I self-treat epididymitis?

You can’t self-treat most cases of epididymitis. It’s important to talk to a healthcare provider for an official diagnosis and treatment. But you can help relieve epididymitis symptoms by:

• Resting.
• Elevating your scrotum.
• Applying ice packs to your scrotum or groin.
• Wearing tight-fitting underwear to reduce swelling.
• Drinking lots of fluids, especially water.
• Taking nonsteroidal anti-inflammatory drugs (NSAIDS) for pain.

Not everyone can take NSAIDS, so talk to a healthcare provider before you take them.

How long does it take epididymitis to heal?

It depends on what causes epididymitis.

In most cases of bacterial infection, you should start to feel better a few days after starting antibiotics. However, swelling can take several weeks to improve. It’s possible to experience discomfort or swelling for weeks or even months after you finish your course of antibiotics.

Tuberculosis epididymitis may take up to nine months for you to heal with medications.

If amiodarone causes epididymitis, you should start to feel better shortly after you reduce your dosage or stop taking it.

In extremely rare circumstances, if a surgeon removes your epididymides or testicles, you may experience worsening pain immediately after surgery due to swelling. It can take several weeks to feel better after surgery. But that doesn’t mean the surgery was ineffective.

Can epididymitis be prevented?

You can help reduce your risk of epididymitis by:

• Using condoms during sexual intercourse.
• Regularly washing your hands with clean water and soap.
• Covering your mouth when you sneeze or cough.
• Staying up to date on vaccines.

What can I expect if I have epididymitis?

In most cases of epididymitis, a healthcare provider will prescribe antibiotics to treat the infection and ease your symptoms. They’ll also give you advice on how to relieve discomfort at home.

While epididymitis can be painful, it usually doesn’t cause any long-term problems, especially with early treatment. Be sure to talk to a healthcare provider as soon as you notice symptoms.

How long does epididymitis last?

Most people who get treatment for epididymitis start to feel better after about three days. But your symptoms may continue for weeks or even months after treatment.

It’s important to finish your full course of antibiotics, even if you start to feel better. If you don’t, epididymitis may return and be harder to treat.

If symptoms return, follow up with a healthcare provider. They can rule out other conditions that affect your testicle. Although testicular cancer rarely causes pain or swelling, routine follow-ups with a provider are important to rule out cancer or conditions.

When should I see a healthcare provider?

Call a healthcare provider if you develop any symptoms of epididymitis. If they conclude that your infection is due to an STI, be sure to let your recent sexual partners know so they can schedule an appointment with a provider and get treatment.

When should I go to the ER?

Head to your nearest emergency room or call 911 (or your local emergency number) if you develop sudden or severe testicular pain.

What questions should I ask a healthcare provider?

If a healthcare provider diagnoses you with epididymitis, you’ll want to learn all you can about your outlook and treatment options. Here are some questions you may want to ask a provider:

• What’s the cause?
• What antibiotics do you recommend?
• Do I need any further testing?
• How long will it take before I feel better?
• How long do I need to avoid sexual activity?
• Should my sexual partner(s) get an STI test?

What can be mistaken for epididymitis?

The following conditions share similar symptoms as epididymitis:

• Testicle infection (orchitis).
• Testicular torsion.
• Testicular tumor.
• Testicular cancer.

What is the difference between epididymitis and orchitis?

Epididymitis refers to inflammation of the tube at the back of your testicle. Orchitis is when your testicle itself swells. These conditions sometimes occur at the same time. When this happens, healthcare providers call it epididymo-orchitis.