Diagnosis

Epididymitis

Inflammation of the epididymis (a tubular structure located on the posterior and superior aspect of the testis where sperms mature).

Etiology

Cause [sae]

  1. Sexually active (<35 years): Sexually transmitted infection accompanied by urethritis

    • C. trachomatis

    • N. gonorrhoeae

    • E. coli

    • Pseudomonas

  2. Men aged >35 years: Retrograde flow of urine

    • Urine retention due to obstructive urinary disease (prostatic hyperplasia)

    • Urinary tract instrumentation

    • Surgery

  3. Males prior to sexual maturity:

    • Trauma

    • Repetitive movements (running, jumping)

    • Sexual abuse (bacterial infections)

    • Chemical (retrograde flow of urine)

    • Drug-induced (amiodarone)

    • Viral infections (mumps)

Pathophysiology [sae]

  1. Bacteria are introduced during sexual intercourse --> migrate to the epididymis

  2. UTI + retrograde flow of urine or stagnation of urine along the genitourinary tract

  3. Bacterial epididymitis

  4. Because of its proximity to the testis --> infection may spread to the testis

Complications [sae]

Risk factors

Epidemiology

Incidence per 100.000 [dsc][rbr]

Epidemiology chart for Incidence

Symptoms & findings

Symptoms

Chills, Dysuria, Fever, Hematospermia, Hematuria, Lymphadenopathy, Prehn's sign, Urethral discharge

Clinical findings

Elevated CRP, Hydrocele, Leukocytosis

Anamneses

Trauma

Localized findings

Pain
Radiates
GenitalInguinalScrotumRegio hypogastrica
Onset
Acute (minutes)Subacute (hours)Gradual (days)
Pattern
Constant
Provoked by
CoitusUrination
Severity
Moderate (4-7)Severe (8-10)
Rash
Radiates
Scrotum
Distribution
Localized
Lesion type
Erythema
Color
Red
Associated symptom
PainSwelling
Palpation
BlanchingPainWarmth
Swelling
Radiates
Scrotum
Onset
Subacute (hours)
Pattern
Constant

Approach

Treatment

Treatment goals:

  1. Microbiologic cure of infection

  2. Improvement of signs and symptoms

  3. Prevention of transmission to others

  4. Decrease in potential complications (e.g., infertility or chronic pain).

Treatment: [ohf]

  1. If caused by repetitive activity:

    • Bed rest + scrotal elevation + analgesics (NSAIDs)

  2. If likely caused by gonococcal or chlamydial infection:

    • Ceftriaxone 250 mg single dose + Doxycycline 100 mg x 2 for 10 days

    If likely caused by enteric organisms or allergic patients:

    • Ofloxacin 300 mg x 2 for 10 days OR Levofloxacin 500 mg x 1 for 10 days

Differential diagnoses

Chlamydia, Gonorrhea, Hydrocele, Inguinal hernia, Leiomyosarcoma, Lipoma, Orchitis, Rhabdomyosarcoma, Sarcoma, Spermatocele, Testicular torsion, Testicular tumor, Torsion of the appendix testis, Trauma, Urinary tract infection, Varicocele

References

[1] Rupp TJ, Leslie SW. Epididymitis. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430814/

[2] Goller JL, De Livera AM, Donovan B, Fairley CK, Low N, Hocking JS. Epididymitis rates in Australian hospitals 2009-2018: ecological analysis. Sex Transm Infect. 2021 Aug;97(5):387-390.

[3] Trojian TH, Lishnak TS, Heiman D. Epididymitis and orchitis: an overview. Am Fam Physician. 2009 Apr 1;79(7):583-7.

[4] Centers for Disease Control and Prevention; Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. 2006 Aug 4;55(RR-11):1-94.

[5] http://emedicine.medscape.com/article/436154 (2014-01-02); [Medscape]

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