Inflammation of the Epididymis: Symptoms, Duration

Brief overview

Symptoms:In acute inflammation, severe pain in testis, groin, abdomen, fever, increased redness and warmth of scrotum, in chronic inflammation, less pain, pressure painful swelling on testis.
Causes and risk factors: Mostly infection with bacteria that have entered the epididymis through the urethra, prostate or urinary tract, sexually transmitted diseases, unprotected sexual intercourse.
Diagnosis: History, palpation, Prehn’s sign, ultrasound examination, blood and urine examination.
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 is either acute or chronic.

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

Testicles and epididymis

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

What are the symptoms of epididymitis?

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

Epididymitis: causes and risk factors

Unprotected sexual intercourse with changing partners is also one of the risk factors for epididymitis. This is because pathogens of sexually transmitted diseases such as chlamydia or gonococci (gonorrhea) are sometimes the cause of epididymitis.

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

Which pathogens trigger the inflammation?

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

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

The rarer viral inflammation of the epididymis usually originates from the mumps virus. In this case, the testis is often affected as well, and epididymitis may precede testicular inflammation. In boys before puberty, epididymitis sometimes follows adenovirus and enterovirus infection (postinfectious epididymitis).

Autoimmune processes may also be a cause of epididymitis.

In addition, there are isolated descriptions of epididymitis triggered by medications such as amiodarone (medication for cardiac arrhythmias).

How can epididymitis be detected?

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 (medical history). Possible questions include:

Have the symptoms started suddenly?
Do you have discharge from the penis or pain when urinating?
Do you have any known urinary tract diseases (including urinary tract infections)?
Do you have unprotected sexual intercourse?

Epididymitis: Physical examination

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

This distinction is very important because testicular torsion is an emergency that requires surgery within a few hours. However, testicular torsion is sometimes accompanied by inflammation of the epididymis. Therefore, if it is not possible to exclude testicular torsion in the examination, surgical exposure of the testicle is necessary.

Epididymitis: laboratory tests.

The doctor will ask you for a urine sample. The suspicion of a urinary tract infection can be quickly confirmed with the help of so-called urine sticks. In addition, the doctor will have a pathogen culture prepared from the urine. This makes it possible to determine the causative pathogen.

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

Epididymitis: Imaging techniques

The urologist recognizes the extent of the inflammation on the ultrasound image and whether the process has already spread to the neighboring testicle. He also recognizes an incipient abscess formation at an early stage in the examination.

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

Treatment

Treatment of epididymitis consists of bed rest, painkillers and, if necessary, antibiotics. It is important to elevate the testicle and cool it with cold compresses. Acute inflammation usually lasts eight to ten days. If the testicle feels less warm and the pain and swelling subside, this indicates that the healing process is underway.

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.

If an abscess (encapsulated collection of pus) forms as a result of epididymitis, it is necessary to open and remove it surgically.

If the epididymitis was triggered by an infection with chlamydia, it is important to treat all sexual partners. Otherwise, new infections (re-infections) are always possible.

If the seminal ducts become stuck due to inflammation (occlusive azoospermia), this can be remedied with microsurgical techniques once the inflammation has subsided: In a procedure called epididymovasostomy, a new continuous passageway is created for the sperm.

What home remedies help with epididymitis?

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

Course of the disease and prognosis

The course of the disease 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.

If epididymitis does not disappear, it is absolutely necessary to see the doctor again. He will clarify by further examinations why the complaints remain.

Frequent or protracted epididymitis in some cases 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). In addition, there is a risk that the inflammation will spread to the neighboring testicle, among others.

In addition to blood poisoning (sepsis), Fournier’s gangrene is a feared complication when epididymitis is very severe and the immune system is weakened. In this case, tissue (necrosis) of connective tissue strands in the testis dies. This results in a severe inflammatory reaction of the entire organism, which is life-threatening.