Epididymitis

Epididymitis – General Information

Epididymitis – Symptoms

Epididymitis is often confused with testicular torsion, and sometimes the two conditions occur at the same time. Tests are needed to distinguish the condition from other scrotal pain causing conditions like variocele (enlarged scrotal veins), testicular cancer, or from a cyst formed within the epididymis. The pains endured by the patients are often similar to pains which occur in cases of hernia. An urologist may be consulted, and tests consist in ultrasound and physical examination. The condition is known to often occur after  infection with Chlamydia trachomatis, Mycobacterium tuberculosis, Neisseria gonorrhea , Scarlet fever, Tertiary syphilis, Typhoid fever, Escherichia coli, Proteus mirabilis, Lymphocytic choriomeningitis or Mumps.

The signs for the condition are referred to as scrotal pain, scrotal swelling, inflammation of the epididymis, epididymal pain, sterile reflux, urinary coliforms, beading of the patient’s vas deferens. Acute Epididymitis often recurs spontaneously months or years after the condition was successfully treated. Left untreated, the condition can evolve into a severe chronic stage leading to complications like abscess, permanent damage or, sometimes, even destruction of the epididymis or the testicle, provoking infertility or hypogonadism. The infection may spread to other organs or systems in the body. In the chronic stage of the disease, inflammation occurs even without an infection, and a longer treatment is needed. Although causes for the chronic phase are unknown, it is believed that the hypersensitivity of nerves and muscles contribute to this.

Epididymitis – Treatment

Epididymitis may be treated with antibiotics such as Doxycyline which often reliefs the symptoms after 2-3 days, but even if the pain completely disappears, that is not a guarantee that the infection was completely eradicated. Sometimes, Epididymitis may trigger high fever that can last up to 6 weeks. In such cases bed rest is recommended. Traditional treatment includes methods like elevation of the scrotum and regularly applying cold compresses to the scrotum. Sometimes, pain is so severe that a direct injection into the nerve tracing along the epididymis is needed. This type of injection contains a compound of a steroid, a high dose of one ore more anti – inflammatory medical products, and pain killers. The procedure is called a cord block and reduces pain for 2 or 3 months. But, some patients present a pain reduction for only 2 or 3 days. The most fortunate patients do not present the condition again, but most times, the procedure is not that efficient, so it may have to be repeated several times until Epididymitis is completely cured, or until the procedure is not efficient any more. In this case, the epididymis may be completely removed through a surgically method, eliminating the cause for good. However, this results in impotence.

Surgical intervention is needed also in the case of an abscess, when a pocket of pus blocks the epididymis. The intervention consists either in the draining of the pus, either in the removal of a part or of the entire epididymis. Other cases when there is a need for surgery are those clinical cases in which Epididymitis is caused by underlying physical defects, or by tuberculosis. Medication treatment slightly differs from younger patients (under 35 years old) to elderly clinical cases. Therapy consists in antibiotics administrated through intra – venous lines, through a shot or with orally administrated pills. For patients younger than 35 years, Ceftriaxone (or Rocephin) administrated as a single shot or through an intra – venous way; Doxycycline (or Vibramycin) consists in pills administrated twice a day for a period of 10 days, added to the Ceftriaxone shot; Ofloxacin (or Floxin) also consists in pills, administrated twice a day for ten days, representing an alternative treatment to Ceftriaxone and Doxycycline. For patients older than 35 years, or for patients who participate in anal intercourse, the therapy involves pills of Ciprofloxacin (or Cipro), that should be taken in twice a day during a period of 10 to 14 days; pills of Ofloxacin (or Floxin), administrated twice a day for about two weeks; Co – trimoxazole (Bactrium DS – double strength), administrated also orally, via pills, twice a day, for a period of 10 to 14 days.

If antibiotics do not work, ultrasound may be used under the surveillance of a specialist in genital conditions. The ultrasound or some blood tests can indicate the presence of a tumor, if it is present. Untreated Epididymitis could progress into orchitis, because of the spreading of the bacteria causing the infection through the blood. The infection is also called epididymo – orchitis, when it is found in the tubes that carry semen from the each testicles.For the effective prevention of the disease, it is recommended for younger than 35 years old men to use condoms, have single partners or abstinence (no sexual relations). As for men older than 35 years, for those who are uncircumcised, keeping a good hygiene is considered vital.