Epididymitis

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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

Mary Nettleman, MD, MS, MACP

Mary Nettleman, MD, MS, MACP

Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.

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• Epididymitis Overview
• Epididymitis Causes
• Epididymitis Symptoms
• When to Seek Medical Care
• Exams and Tests
• Epididymitis Treatment
• Medications
• Next Steps
• Follow-up
• Prevention
• Outlook
• Synonyms and Keywords
• Authors and Editors
• Read more on Testicle Infection (Epididymitis) from Healthwise
• Viewer Comments: Testicle Infection (Epididymitis) - Symptoms
• Viewer Comments: Testicle Infection (Epididymitis) - Treatments

Epididymitis Overview

Epididymitis is infection or less frequently, inflammation of the epididymis (the coiled tube on the back of the testicle). The majority of men that develop epididymitis develop it because of a bacterial infection. Although males of any age can develop epididymitis, it occurs most frequently between ages of 20 to 39. When it develops in children, it is usually due to inflammation caused by trauma. However, some children develop it because of bacterial infections, some of which may be due to sexual abuse. In general, individuals have discomfort and pain in the area of the testicle(s) or groin; some may develop fever, penile discharge and blood in the urine.

The epididymis is a firm tube that lies on the back surface of each testicle. It is coiled in order to fit a length of nearly 20 feet into a small space. This long length acts as a storage space for the sperm and gives sperm time to mature. The epididymis can be divided into three sections: 1) the head (an expanded upper end), 2) the body, and 3) the pointed tail.

The epididymis also absorbs fluid and adds substances to help nourish the maturing sperm. Each epididymis is directly attached to the testicle so that if the epididymis becomes infected or develops inflammation, the testicle may also develop infection or inflammation. This is termed epididymo-orchitis (infection/inflammation of both the epididymis and testicle). Also, testicular infection is the most common reason for inflammation in the scrotum. The other end of the epididymis attaches to the vas deferens which leads to the prostate gland and then to the urethra. Infections and inflammation often proceed retrograde (also termed backflow) from the urethra; rarely is infection/inflammation spread through the blood to the epididymis.

Epididymitis Causes

The cause of epididymitis is usually a bacterial infection. The bacteria usually get to the epididymis by moving back through (retrograde) the urethra, prostate, vas deferens into the epididymis. The responsible bacteria are usually identified in about 80% of cases.

Two main groups of organisms cause most cases of epididymitis: sexually transmitted organisms and coliforms (organisms that commonly live in the intestines).

• In men younger than about 39 years of age, the causes are usually the same organisms that cause the sexually transmitted diseases of chlamydia (responsible for nearly 50%-60% of cases) and gonorrhea. The bacterial species are Chlamydia trachomatis and Neisseria gonorrhea, respectively.
  
  
• In those older than 39 years of age, the causes are usually coliforms, which are bacteria (such as Escherichia coli) that live in the intestines. These organisms also frequently cause bladder infections. Any age of men who participate in anal intercourse are more likely to get infected with E. coli or other fecal bacteria. Epididymitis is rarely caused by fungi or Mycobacterium spp.
  
  
• Chemical epididymitis (rare) is inflammation caused by the retrograde (backward) flow of urine when exercising or having sex with a full bladder.
  
  
• Amiodarone (Nexterone), a frequently used heart medication, occasionally causes inflammation of the epididymis.
  
  
• Viral infections (including mumps), mainly in the pediatric population.