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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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Exams and Tests

A health care practitioner will take a detailed history (including a sexual history), collect a urine sample, and perform a physical examination, including a prostate exam.

Laboratory Tests

• Urinalysis and urine culture: These tests aid in the diagnosis of a urinary tract infection (bladder infection).

• Urethral culture

• Urine can be tested for sexually transmitted diseases present in the urethra.

• Sometimes a swab is inserted about one-half inch into the urethra and sent for testing (although uncomfortable, it only takes a few seconds).

• The results usually take about a day to come back to the health care practitioner, so follow-up is very important.


• The health care practitioner often also orders other tests such as a white blood cell count. A white blood cell count may be high if infection is present. A Gram-stain of urethral exudates, in some cases, can presumptively diagnose the infecting bacteria.
  
  
• There are several rapid tests for some of the bacteria that cause epididymitis (N. gonorrhea, C. trachomatis). They detect the organisms by PCR and immunological methods. However, these tests usually require confirmation by actually culturing the bacteria.

Imaging Tests

• Ultrasound and nuclear scans help differentiate testicular torsion from epididymitis.
  
  
• CT and MRI scans are used occasionally to help determine and differentiate between many conditions that can cause some symptoms similar to epididymitis (for example, cysts, hydrocele formation (fluid filled area), hernias, cancerous tissue, or the extent of abscesses or gangrene in swollen testicles).

The correct diagnosis of the cause of epididymitis by health care practitioners is important because an incorrect diagnosis may lead to many problems beyond the symptoms in the individual. The majority of infections involving the epididymis (over 50%) are due to sexually transmitted infectious agents or by bacteria acquired during anal intercourse. Consequently, sexual partners of many patients should be notified and treated, even if they currently show no symptoms. However, many men (usually older than 39 years of age) and some children can acquire the disease without it being linked to sexual transmission (for example, bladder infection or chemical inflammation). Consequently, health care practitioners need to take a detailed history from the patient, and the patient has the responsibility to answer medical history questions honestly. The situation is even more complex when children have symptoms of epididymitis; most experts suggest that a Child Protective Agency be contacted if sexual abuse is suspected.