The epididymis is a ductal system behind the testis and serves as a conduit for sperm produced in the testicle to be transported into the Vas Derferens to eventually reach the urethra. Epididymitis is a condition where the epididymis becomes inflamed usually from an infection, though trauma and autoimmune disease is a possible cause.
Signs & Symptoms
Symptoms of epididymitis include localised testicular pain and swelling of the posterior aspect of the testicle. The area can sometimes be warm to touch with redness of the scrotal skin. The area will be painful when being examined with relief of the pain achieved when the area is elevated.
Severity and etiology of epididymitis varies with the age of the patient. For young children presenting with testicular pain, a diagnosis of Testicular Torsion needs to be considered first, after which a mumps infection affecting the testicle needs to be ruled out. For sexually active men under 35 years of age, Gonorrhea and Chlamydia are the 2 most common organisms responsible for epididymitis. In older patients, epididymitis can occur concurrently with prostatitis especially if there is an underlying prostatic obstruction such as Benign Prostatic Hyperplasia (BPH) or recent catheterization.
Most cases of epididymitis can be treated outpatient with oral non-steroidal antiinflamatory drugs (NSAIDS), local application of ice and oral antibiotics. A urine test is sometimes done to determine the organism causing the infection. Patients with epididymitis generally improve within 48 – 72 hours. If the symptoms do not abate within that period, an alternative diagnosis needs to be considered and further imaging such as a scrotal ultrasound performed.