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People with testicles may get a condition known as epididymitis, which can cause pain and swelling in the testicles. The condition usually improves with antibiotics.
Epididymitis is an inflammation of the epididymis. The epididymis is a tube located at the back of the testicles that stores and carries sperm. When this tube becomes swollen, it can cause pain and further swelling in the testicles.
This infection can develop in people of all ages who have testicles, but it’s most common in those between ages 20 and 40. It usually occurs due to a bacterial infection or a sexually transmitted infection (STI).
The condition usually improves after you take antibiotics. Acute epididymitis lasts 6 weeks or fewer.
In most cases, the testes also experience inflammation. It can be difficult to tell whether the testes, epididymis, or both are inflamed. That’s why healthcare professionals commonly use the term “epididymo-orchitis” to account for infection in both parts of the reproductive system.
Chronic epididymitis, on the other hand, lasts 6 weeks or more.
Epididymitis may begin with only a few mild symptoms. Without treatment, however, the symptoms tend to get worse.
People with epididymitis may experience:
- low grade fever
- pain in the pelvic area
- pressure in the testicles
- pain and tenderness in the testicles
- redness and warmth in the scrotum
- enlarged lymph nodes in the groin
- pain during sexual intercourse and ejaculation
- pain during urination or bowel movements
- urgent and frequent urination
- abnormal penile discharge
- blood in the semen
STIs are a common cause of epididymitis, with gonorrhea and chlamydia being the most common. These can cause an infection in the urethra. They sometimes travel down the vas deferens to the epididymis or testes to cause further inflammation there.
Nonsexually transmitted infections, such as those that come from urinary tract infections (UTIs) or tuberculosis (TB), can travel from the urethra or other parts of the body to infect or cause inflammation of the epididymis.
However, a nonsexually transmitted infection, such as a UTI or prostate infection, can also cause epididymitis.
You may be at a higher risk for epididymitis if you:
- are uncircumcised
- have sex without a condom or other barrier method
- have structural problems within the urinary tract
- have TB
- have an enlarged prostate causing blockage in the bladder
- recently had urinary tract surgery
- recently experienced a groin injury
- use a urinary catheter
- use a heart medication called amiodarone
Children can get epididymitis just like adults, though inflammation is more likely to have a different cause.
Common causes of epididymitis in children include:
- direct trauma
- UTIs that spread to the urethra and epididymis
- reflux of urine into the epididymis
- torsion, or twisting, of the epididymis
Symptoms of epididymitis in children include:
- discharge from the urethra
- discomfort in the pelvis or lower abdomen
- pain or burning during urination
- redness or tenderness of the scrotum
The treatment of pediatric epididymitis will depend on the underlying cause of the condition.
In many causes, the condition may resolve on its own, aided by rest and pain relievers like ibuprofen. In a bacterial infection, like one due to a UTI, a healthcare professional may prescribe antibiotics.
A healthcare professional will also advise children to avoid “holding it in” when they need to use the bathroom and to drink more water.
Most cases of acute epididymitis resolve after people use antibiotics. There are usually no long-term sexual or reproductive concerns.
However, the infection can return in the future. It’s also possible for complications to occur, but this is rare. These may include:
- chronic epididymitis
- epidydimal abscess
- a co-occurring infection of the testicle known as epidydimo-orchitis
- a testicular abscess
- sepsis, in the case of severe infection
- sterility due to blocked sperm ducts
- testicular shrinkage and tissue death
- fistula, or an abnormal passageway, in the scrotum
To prevent these, it’s important to speak with a healthcare professional about epididymitis as soon as you recognize symptoms.
Your doctor will first complete a physical examination. They’ll look for swelling of the testicles and the lymph nodes in the groin area, as well as abnormal discharge from the penis. If there’s discharge, your doctor will use a cotton swab to collect a sample and test for STIs.
Your doctor may also perform the following tests and procedures:
- rectal examination, which can show if an enlarged prostate caused your condition
- blood tests, such as a complete blood count (CBC), to determine whether there’s an infectious pathogen in your system
- urine sample, which can indicate if you have a urinary tract infection or an STI
Imaging tests may be done to rule out other conditions. These tests produce detailed images that allow your doctor to see structures in the body very clearly. Your doctor might order a testicular ultrasound to get images of the testicles and the surrounding tissues in the scrotum.
Treatment for epididymitis involves treating the underlying infection and easing symptoms.
Common treatments include:
- antibiotics like
doxycycline and ceftriaxone, which a healthcare professional administers for 4 to 6 weeks for people with chronic epididymitis
- pain medication, which can be available over the counter (like ibuprofen) or might require a prescription depending on its strength (like codeine or morphine)
- bed rest
Additional treatments may include:
- elevating the scrotum for at least 2 days if possible
- applying cold packs to the scrotum (buy a cold pack)
- wearing an athletic cup for support (buy one here)
- avoiding lifting heavy objects
In cases of an STI, you and your partner should abstain from sexual intercourse until you’ve completed your course of antibiotics and are fully cured.
These methods are usually successful. It can sometimes take several weeks for the soreness or discomfort to go away completely. Most presentations of epididymitis clear up within 3 months. However, more invasive treatment may be necessary for some people.
If an abscess has formed on the testicles, your physician can drain the pus using a needle
Surgery is another option if no other treatments have been successful. This involves removing all or part of the epididymis. Surgical interventions may also be necessary to correct any physical anomalies that may be causing epididymitis.
Sometimes, it isn’t possible to prevent epididymitis. However, you can reduce your risk for infection with the following measures:
- using a condom or other barrier method to prevent STIs
- reducing your number of sexual partners
- receiving an adult male circumcision
- regularly disinfecting and cleaning shared toilet seats after use
- receiving a TB vaccination
However, receiving prompt treatment for acute or mild epididymitis can prevent a chronic infection.
If you’re experiencing persistent pain or discomfort, make an appointment with your doctor, especially if the symptoms don’t improve within 4 days. If you’re experiencing severe pain in the scrotum or have a high fever, seek medical attention immediately.
A healthcare professional can rule out other conditions or prescribe medications while the infection is still acute.
It’s important to seek treatment right away to prevent complications. Once you receive treatment, take your entire course of antibiotics to treat the infection, even if you feel symptom-free.
You should also check in with your doctor after finishing the medication to make sure that the infection has cleared. This will help ensure that you make a complete recovery.