Epididymitis

When the epididymis, a tube running behind the testicles, becomes swollen or infected, a layperson might begin to suspect a kidney or bladder infection.  However, that’s probably not the correct answer, since such infections in men are rather uncommon. 

No, the swelling, pain, and tenderness in the scrotum (usually one-sided) of epididymitis is probably due to something else.  It afflicts about 600,000 males annually in the US, mostly between the ages of 14 and 35, and is most frequently—but not always!—an STD.[1]

There are two forms of epididymitis, acute and chronic. Acute is characterized by sudden onset and most likely to be a bacterial infection.  With the chronic form, the pain lasts much longer, for six weeks or more, is less severe, and comes and goes.[2]

(However, if associated with flu-like symptoms, swollen glands, and if both testicles are tender, the patient probably has the mumps.[3])

Signs and symptoms

• Painful urination[4] [5] [6]
• Pain at the back of the scrotum[7] [8]
• Swollen testicle[9] [10]
• Blood in the semen[11] [12]
• Frequent urination[13]
• Fever[14] [15] [16]
• Chills[17]
• Nausea and/or vomiting[18]
• Urinalysis strips may indicate red and white blood cells[19]
• If lifting the affected testis relieves the pain, epididymitis is the likely culprit.[20]

Causes

• STDs, usually gonorrhea or chlamydia[21] [22]
• Backflow of infected urine (usually E. coli) down the urethra[23]
• Catheter usage[24] [25]
• Injury to the groin[26] [27]
• Urine blockage in the urethra[28] [29]
• Prostatitis[30] [31]
• Tuberculosis[32]
• Amiodarone (arrhythmia medication) [33]

Treatment, if caused by bacterial infection:

• Ofloxacin, 300 mg, 2x per day, 10 days[34]
• Levofloxacin, 500 mg per day[35]
• Ciprofloxacin, 500 mg, 2x per day[36], 10 days[37]
• Doxycycline, 100 mg, 2x per day[38], 10 days[39]
• SMZ/TMP[40]

Pain management

• Rest[41]
• Drink lots of fluids[42]
• Wear tight-fitting underwear[43]
• Elevate the scrotum[44]
• Ice packs[45] [46]
• NSAIDs[47] [48]

Failure to treat epididymitis may cause abscess formation, infertility, and/or an infection in the testicles.[49]

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[1] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[2] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[3] Survival and Austere Medicine, 3^rd Edition, 2017, 144.

[4] Survival and Austere Medicine, 3^rd Edition, 2017, 144.

[5] Joseph Alton, et al., Survival Medicine Handbook, 4^th Edition, 2021, 312.

[6] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[7] Joseph Alton, et al., Survival Medicine Handbook, 4^th Edition, 2021, 312.

[8] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[9] Joseph Alton, et al., Survival Medicine Handbook, 4^th Edition, 2021, 312.

[10] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[11] Joseph Alton, et al., Survival Medicine Handbook, 4^th Edition, 2021, 312.

[12] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[13] Survival and Austere Medicine, 3^rd Edition, 2017, 144.

[14] Survival and Austere Medicine, 3^rd Edition, 2017, 144.

[15] Joseph Alton, et al., Survival Medicine Handbook, 4^th Edition, 2021, 312.

[16] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[17] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[18] Survival and Austere Medicine, 3^rd Edition, 2017, 144.

[19] Survival and Austere Medicine, 3^rd Edition, 2017, 144.

[20] Survival and Austere Medicine, 3^rd Edition, 2017, 144.

[21] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[22] Joseph Alton, et al., Survival Medicine Handbook, 4^th Edition, 2021, 312.

[23] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[24] Joseph Alton, et al., Survival Medicine Handbook, 4^th Edition, 2021, 312.

[25] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[26] Joseph Alton, et al., Survival Medicine Handbook, 4^th Edition, 2021, 312.

[27] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[28] Joseph Alton, et al., Survival Medicine Handbook, 4^th Edition, 2021, 312.

[29] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[30] Joseph Alton, et al., Survival Medicine Handbook, 4^th Edition, 2021, 312.

[31] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[32] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[33] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[34] Cynthia Koelker, Armageddon Medicine, 2012, 192.

[35] Cynthia Koelker, Armageddon Medicine, 2012, 192.

[36] Cynthia Koelker, Armageddon Medicine, 2012, 192.

[37] Survival and Austere Medicine, 3^rd Edition, 2017, 144.

[38] Cynthia Koelker, Armageddon Medicine, 2012, 192.

[39] Survival and Austere Medicine, 3^rd Edition, 2017, 144.

[40] Joseph Alton, et al., Survival Medicine Handbook, 4^th Edition, 2021, 312.

[41] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[42] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[43] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[44] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[45] Joseph Alton, et al., Survival Medicine Handbook, 4^th Edition, 2021, 312.

[46] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[47] Joseph Alton, et al., Survival Medicine Handbook, 4^th Edition, 2021, 312.

[48] https://my.clevelandclinic.org/health/diseases/17697-epididymitis

[49] Cynthia Koelker, Armageddon Medicine, 2012, 192.