Epididymitis: Causes, Symptoms, and Treatment

Epididymitis is inflammation of the tube that connects the testicle with the vas deferens. The tube is called the epididymis.

Causes of Epididymitis

Most young men between the ages of 19 to 35 experience epididymitisIt is most often caused by the spread of a bacterial infection which often begins in the urethra, the prostate, or the bladder. Infections like gonorrhea and chlamydia are most often the cause of epididymitis in young heterosexual men. In children and older men, including homosexual men, it is more commonly caused by E coli and similar bacteria.

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Mycobacterium tuberculosis (TB) can cause epididymitis. Other bacteria such as ureaplasma may also cause the condition to develop. Amiodarone is a medicine which prevents irregular heart rhythms. It can also cause epididymitis to develop.

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The following increase the risk for epididymitis:

  • Past structural problems in the urinary tract
  • Recent surgery
  • Enlarged prostate
  • Regular use of a urethral catheter
  • Sexual intercourse with more than one partner and not using condoms

Symptoms of Epididymitis

Epididymitis may begin with:

  • Chills
  • Low fever
  • Feeling of heaviness in the testicle area

As the testicle area become more sensitive to pressure when the condition progresses, an infection in the epididymis can easily spread to the testicle.

Other severe symptoms include:

  • Blood in the semen
  • Discharge from the urethra (the opening at the end of the penis)
  • Discomfort in the lower abdomen or pelvis
  • Lump near the testicle

Less common symptoms are:

Symptoms of epididymitis may be similar to those of testicular torsion, which requires emergent treatment.


Physical exam will indicate a red, tender lump on the affected side of the scrotum. You may have tenderness in a small area of the testicle where the epididymis is attached. A large area of swelling may grow around the lump. The lymph nodes in the groin area may be engorged. There may also be discharge from the penis. A rectal exam may point to an enlarged or tender prostate.

Tests that may be performed include:

  • Urinalysis and culture
  • Complete blood count (CBC)
  • Doppler ultrasound
  • Testicular scan (nuclear medicine scan)
  • Tests for chlamydia and gonorrhea


Sexually transmitted infections require antibiotics that will be prescribed by your doctor. Your sexual partner should also be treated. You may need pain medicines and anti-inflammatory medicines.

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If you are taking amiodarone, you may need to lower your dose or change your medicine. Discuss with your doctor.

To ease pain and discomfort:

  • Lie down with the scrotum
  • Apply ice packs to the sore area.

Possible Complications

Complications include:

  • Infertility
  • Abscessin the scrotum
  • Long-term (chronic) epididymitis
  • Opening on the skin of the scrotum
  • Death of testicular tissue due to lack of blood

Sudden and severe pain in the scrotum is a medical emergency. You need to be seen by a provider right away.

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Complications can be prevented with early detection and treatment.

  • Antibiotics may be prescribed prior to a surgery because surgeries could raise the risk for epididymitis.
  • Practice safe sex.
  • Avoid multiple sexual partners and use condoms.


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