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Epididymitis: symptoms, duration

by Josephine Andrews
Published: Last Updated on 294 views

Epididymitis is inflammation of the epididymis . The epididymis is then usually swollen, hard and very painful. Bacteria are often the cause of epididymitis. Early treatment is very important to avoid complications. It includes bed rest, pain medication, and possibly antibiotics. Read everything you need to know about symptoms, diagnosis and treatment of epididymitis here!

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

N45

quick overview

  • Symptoms: In acute inflammation, severe pain in the testicles, groin, abdomen, fever, increased redness and warmth of the scrotum, in chronic inflammation, less pain, tender swelling in the testicles
  • Causes and risk factors: Mostly infection with bacteria that have entered the epididymis via the urethra, prostate or urinary tract, venereal diseases, unprotected sex
  • Treatment: bed rest, cooling compresses, elevated testicles, pain killers
  • Diagnosis: history, palpation, Prehn’s sign, ultrasound, blood and urine tests
  • Prognosis and course: Good prognosis with early treatment, known complications are abscesses and infertility
  • Prevention: protected sexual intercourse, timely treatment of urological infections

What is epididymitis?

Epididymitis occurs in most cases as a side effect of bacterial inflammation of the prostate or urinary tract. It rarely affects the epididymis in isolation because the pathogens spread along the vas deferens. Epididymitis usually occurs after puberty.

Epididymitis is either acute or chronic.

The duration of epididymitis is variable. The symptoms often improve after about a week. However, it can sometimes take up to six weeks for all symptoms to disappear.

testicles and epididymis

Like the penis and testicles, the epididymis is one of the male sex organs. The testicles and epididymis lie together in the scrotum ( scrotum). The testicles produce semen and sex hormones. At the upper pole of the testicle, the fresh semen is directed into the epididymis and stored there. The vas deferens emerges from the epididymis and opens into the urethra in the area of ​​​​the prostate gland (prostate).

Although the testicles and epididymis are close together and closely connected, inflammation of the testicles (orchitis) is not the same as inflammation of the epididymis (epididymitis). The latter is much more common. However, in some cases, the inflammation affects both testicles and epididymis. In this case one speaks of epididymorchitis.

What are the symptoms of epididymitis?

Typical symptoms of epididymitis are acute pain in the testicles. Also, the epididymis is swollen. Doctors also refer to this as “acute scrotum”. The skin of the testicles shows signs of inflammation such as overheating and reddening. The pain often radiates to the groin and lower abdomen. Accompanying symptoms of epididymitis include fever up to 40°C as well as vomiting and nausea.

Chronic epididymitis is sometimes characterized by painless swelling. Epididymitis caused by chlamydia causes relatively few symptoms.

Epididymitis: causes and risk factors

The most common causes of epididymitis include bacterial inflammation of the urinary tract and the prostate. As a rule, the pathogens reach the epididymis from the urethra or the prostate via the vas deferens. One then speaks of an “ascending (ascending) infection”.  

Unprotected sex with different partners is also one of the risk factors for epididymitis. Because sometimes pathogens of sexually transmitted diseases such as chlamydia or gonococci (gonococci) are the cause of epididymitis.

Men with bladder emptying disorders, malformations in the urogenital area and a permanent bladder catheter therefore have a particularly high risk of developing the disease. In children, malformations of the urinary tract are primarily responsible for the bacteria getting into the epididymis.

In some cases, testicular torsion, which is a twisting of the testicles, leads to epididymitis. In many cases, however, the epididymis is not inflamed in isolation, but together with the neighboring sections of the seminal and urinary tract.

Which pathogens trigger the inflammation?

The most common cause of epididymitis is bacteria – in contrast to testicular inflammation, which is usually caused by viruses . In the case of (sexually active) men under the age of 35, these are often pathogens of venereal diseases such as Chlamydia trachomatis. More rarely, gonorrhea pathogens (gonococci) lead to inflammation of the epididymis.

In men over 35 years of age, intestinal bacteria such as Escherichia coli, enterococci, Klebsiella or Pseudomonas aeruginosa and staphylococci are primarily responsible for epididymitis.

More rarely, epididymitis is caused by the spread of bacteria through the bloodstream (especially pneumococci and meningococci), as part of tuberculosis or trauma: when urine flows into the seminal ducts, it irritates the epididymis and causes inflammation.

Other possible causes

The rarer viral inflammation of the epididymis is usually caused by the mumps virus. In this case, the testicles are often involved, with epididymitis possibly preceding testicular inflammation. In prepubescent boys, epididymitis sometimes follows adenovirus and enterovirus infection (postinfectious epididymitis).

Autoimmune processes are also possible causes of epididymitis.

Fungi (Candida, Coccidioides, Histoplasma et cetera) and worms (Schistosoma, Wucherichia or Echinococcus) are very rarely the cause of epididymitis in Central Europe.

There are also isolated descriptions of epididymitis triggered by drugs such as amiodarone (medicine against cardiac arrhythmias).

How is epididymitis diagnosed?

If epididymitis is suspected, it is advisable to consult a urologist. The doctor will first talk to you in detail about your symptoms and any underlying diseases (anamnesis). Possible questions are for example:

  • How long have the complaints existed?
  • Did the symptoms start suddenly?
  • Do you have penile discharge or painful urination?
  • Do you already have diseases of the urinary tract (including urinary tract infections)?
  • Do you have unprotected sex?

Epididymitis: Physical Examination

This is followed by the physical examination. The doctor will first examine the scrotum for visible signs of inflammation (overheating, redness) and check whether the epididymis is swollen.

Then the doctor lifts the scrotum. If the symptoms decrease as a result (Prehn’s sign positive), this indicates epididymitis. In the case of testicular inflammation and testicular torsion (rotation of the testicles around its own axis), however, lifting the scrotum does not improve the symptoms.

This distinction is very important because testicular torsion is an emergency that requires surgery within a few hours. However, testicular torsion sometimes accompanies inflammation of the epididymis. If it is not possible to rule out testicular torsion during the examination, the testicle must be exposed surgically.

If an abscess (encapsulated collection of pus) has formed in the area of ​​the epididymis, the doctor feels it as a fluctuating swelling.

Epididymitis: laboratory tests

The doctor will ask you for a urine sample. With the help of so-called urine sticks, the suspicion of an infection of the urinary tract can be quickly confirmed. In addition, the doctor has a pathogen culture made from the urine. This makes it possible to identify the causative agent.

The laboratory also tests the bacteria for their sensitivity to antibiotics (resistogram). In addition, if epididymitis is suspected, the doctor takes a smear from the entrance to the urethra and has it examined in the laboratory.

In the case of epididymitis, the blood test shows typical signs of inflammation (such as an increased number of white blood cells). If a mumps virus infection is suspected, antibodies in the blood indicate the infection.

Epididymitis: imaging techniques

If epididymitis is suspected, the ultrasound examination of the testicles (testicular sonography) is particularly important for diagnosis. It can be repeated at any time and is completely safe. Sonography is therefore excellently suited to assessing the course of the disease.

The urologist recognizes the extent of the inflammation on the ultrasound image and whether the process has already spread to the neighboring testicles. During the examination, he also recognizes the beginning of an abscess formation at an early stage.

If there is a suspicion of a drainage obstruction in the urinary system, which forces the urine into the vas deferens and testicles, X-ray examinations can be considered in addition to the ultrasound examination. Constrictions in the urethra (urethral strictures) can be visualized with the help of contrast media (urography).

If necessary, a measurement of the urinary stream or a cystoscopy can help to narrow down the exact cause.

treatment

Therapy for epididymitis consists of bed rest, painkillers and, if necessary, antibiotics. It is important to elevate the testicles and cool them with cold compresses. The acute inflammation usually lasts eight to ten days. If the testicles feel less warm and the pain and swelling beneath, this speaks for the healing process.

In this case, the patient is allowed to stand up. He is given a jockstrap (a bag-shaped bandage to protect the testicles) to keep the epididymis and testicles from descending.

If the pain is severe, the spermatic cord is infiltrated with local anesthetics (agents for local anesthesia). There is an increased risk of thrombosis during bed rest. To prevent blood clots, the patient may therefore be injected with anticoagulant heparin.

In children, a malformation of the urinary tract that impedes the outflow of urine usually leads to epididymitis. In order for the healing to start more quickly, the urine is often temporarily drained directly from the bladder (puncture cystostomy). Sometimes, after treatment of the epididymitis, surgical correction of the malformation is necessary.

If an abscess (encapsulated collection of pus) forms as a result of the epididymitis, it must be surgically opened and removed.

If an infection with chlamydia caused the epididymitis, it is important to treat all sex partners as well. Otherwise, repeated infections (re-infections) are possible.

In the case of a chronic course, the treatment lasts longer (especially the administration of antibiotics). In rare, very severe cases, the epididymis must be surgically removed (epididymectomy) or the spermatic cord severed (vasectomy). 

If the seminal ducts stick together due to inflammation (occlusive azoospermia), this can be remedied with microsurgical techniques after the inflammation has subsided: A new, continuous path for the sperm is created as part of the so-called epididymovasostomy.

What home remedies help with epididymitis?

A testicle bench or a small pillow are helpful to elevate the testicles. It is also important to cool the testicles. Cool packs from the pharmacy or quark wraps are suitable home remedies for epididymitis. The cooled quark is applied to a clean kitchen towel, wrapped and placed on the testicles.

Home remedies have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.

Course of the disease and prognosis

The course of epididymitis requires patience: the healing process of epididymitis sometimes takes up to six weeks – even with optimal treatment. Only then does the scrotum feel normal again in many men.

As long as there is pain from the epididymitis, it is advisable to refrain from sports.

If the epididymitis does not go away, it is imperative to see the doctor again. He will clarify through further investigations why the complaints remain.

Epididymitis usually heals well. However, complications are possible, such as fistulas, local destruction of the epididymal tissue and propagation of the inflammation along the seminal and urinary tract. Occasionally, the focus of inflammation (abscess) encapsulates itself in the case of pronounced epididymitis. Then an operation is required.

In some cases, frequent or delayed epididymitis leads to scarring and narrowing of the epididymis or vas deferens. If both vas deferens are stuck together so that they are impermeable to sperm, this leads to infertility (occlusive azoospermia). There is also a risk that the inflammation will spread to the neighboring testicles, among other things.

In the case of recurring inflammation of the epididymis, the only solution is often an operation to cut the spermatic cord (vasectomy) or to remove the epididymis (epididymectomy). In advanced stages of the inflammation, in rare cases, the testicles may also need to be removed.

In addition to blood poisoning (sepsis), the so-called Fournier gangrene is a feared complication if the epididymitis is very severe with a weakened immune system. Tissue dies (necrosis) from connective tissue strands in the testicles. This entails a severe inflammatory reaction of the entire organism, which is life-threatening.

Can epididymitis be prevented?

There is no general measure that can be used to prevent epididymitis. However, if there is a suspicion of a urinary tract infection, it is important to have it treated early. It is also advisable for men who have urinating problems to seek urological treatment.

If the doctor treats such diseases carefully, it is less likely that the bacteria involved will ascend into the vas deferens. In this way, epididymitis can be indirectly prevented.

For men who frequently have different sexual partners, it is highly advisable to use condoms . This reduces the risk of contracting sexually transmitted diseases. In this way, they prevent epididymitis caused by gonococci or chlamydia.

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