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Epididymitis

Epididymitis – Causes, Diagnosis and its Treatment

 

Introduction

Epididymis is a coiled tube that connects the testis to the vas deferens and is located behind the testis. It carries as well as stores sperms till maturation. Epididymitis is a condition of acute or chronic pain in the epididymis due to various causes. The pain is cyclic or recurring in nature and may last for a few minutes or for as long as several days. The pain is also at times accompanied by inflammation, redness and warmth in the epididymis which can then spread to the scrotal area as well. While some symptoms of epididymitis can be confused with other disorders such as testicular torsion or inguinal canal; the onset and pathology of this medical condition is very different.

Risk Factors

Although Epididymitis is commonly considered to be a sexually transmitted disorder, there are non-sexual risk factors as well. Men in their early 40s are mostly at the risk of epididymitis and in most cases, the infection as well as the pain remains for as long as five years before patients seek any professional help. Urinary tract infections and subsequent surgeries can substantially increase the risk of epididymitis. An enlarged prostate causing blockage in the bladder can also heighten the risk of this contracting epididymitis. Diseases like tuberculosis which compromise the immunity of human body can also expose a person to epididymitis causing bacteria. If left untreated, this condition can further lead to acute onset scrotal pain. Advanced stage complications can also cause testicular shrinkage, death of testicle tissue and infertility.

Causes

Epididymitis is most commonly caused by bacterial infection and various strains of bacteria can be responsible for this condition. Depending upon the duration and severity of the symptoms, the disease is classified into three categories – chronic, sub-acute and acute. Commonly observed causes of epididymis are –

  • Chlamydia trachomatis: Responsible for causing acute epididymis in sexually active men by way of urinary tract infection.
  • Neisseria gonorrhea: This is the second most significant causal agent of epididymis.
  • E. coli: It can cause urinary tract obstruction, especially in older men or boys who are pre-pubescent or have just reached puberty. This can in turn result in epididymitis wherein only one side of the scrotum is affected.
  • Non-infectious epididymitis: In reflux of urine happens through the ejaculatory duct, obstruction and inflammation of epididymis can occur. The urine need not be infected with bacteria for epididymitis to onset. Children can also suffer from this condition following infections of enterovirus, adenovirus or Mycoplasma pneumoniae.
  • Chemical epididymitis: As a result of continual intake of drugs such as amiodarone, epididymitis condition can also develop.
  • Surgery induced epididymitis: Chronic Epididymitis can be an aftermath of various surgical procedures such as prostatectomy, genito-urinary surgery and vasectomy.

Diagnosis

Diagnosis of epididymitis can be done by considering the symptoms manifested by the patient. However, for confirmation of the disease, various diagnostic tests can be performed.

  • Symptoms of epididymitis: The foremost diagnosis of the condition can happen by physical examination and consideration of patient’s medical history. There are distinct symptoms which can indicate presence of epididymitis. These are inflammation, redness and warmth in the area behind testis. Urgent, frequent and often painful urination is also a commonly observed symptom. Pain at the time of intercourse, ejaculation and blood in semen also accompany epididymitis condition. Tenderness and lump formation in the groin area is also a symptom which is accompanied by fever in case of chronic epididymitis.
  • Blood test: As epididymitis can also be caused due to unsafe sex and with other sexually transmitted diseases; blood tests help in diagnosis by way of complete blood count (CBC) and presence of STIs.
  • Urine test: Urine tests are conducted to identify the type of bacterial strain which is causing the infection. Urinary tract infection and complications are also identified with the tests of urine samples.
  • Imaging tests and Doppler ultrasound: This is the most effective non-invasive diagnostic technique which can distinguish between epididymitis and testicular torsion by analyzing areas of blood flow.

Treatment for Epididymitis

As in majority of cases, epididymitis occurs due to bacterial infection; commonly preferred treatment options are antibiotic. Azithromycin and cefixime are used to treat bacterial infections of the urinary tract caused by chlamydia and gonorrhea. For infections caused by E. coli, ofloxacin and levofloxacin are the recommended treatment measures. Doxazosin, a prostate related medicine, is also known to be effective in case of epididymitis. As both chronic and acute forms of epididymitis can take weeks to cure, despite treatment, pain alleviation measures are also recommended by the doctors. These include elevation of scrotum and usage of cold compresses to reduce the inflammation, warmness, swelling and pain in the epididymis.