Epididymitis is inflammation of the epididymis, which is a tube located at the back of the testicles. The tube stores and carries sperm. Epididymitis is most common in men aged 19 to 35 and is a frequent cause of military hospitalizations. Epididymitis is caused by an infection, usually a bacterial or a sexually transmitted infection. The condition usually improves with antibiotics. Epididymitis is a significant cause of morbidity and is the fifth most common urologic diagnosis in men aged 18-50 years. Epididymitis must be differentiated from testicular torsion, which is a true urologic emergency.
Epididymitis can be caused by a nonsexual infection, such as urinary tract infections (UTIs) and prostate infections. However, the most common cause of epididymitis are sexually transmitted infections (STIs)—specifically gonorrhea and chlamydia. The following history findings are associated with acute epididymitis and orchitis gradual onset of scrotal pain and swelling, often developing over several days, usually located on 1 side, dysuria, frequency, or urgency, fever and chills, usually, no nausea or vomiting, urethral discharge preceding the onset of acute epididymitis.
The following history findings are associated with chronic epididymitis, Long-standing (>6 weeks) history of pain, either waxing and waning or constant, scrotum that is not usually swollen but may be indurated in long-standing cases. The exact etiology of acute epididymitis is unclear; however, it is believed to be caused by the retrograde passage of urine from the prostatic urethra to the epididymis via the ejaculatory ducts and vas deferens. Obstruction of the prostate or urethra and congenital anomalies create a predisposition for reflux.
An estimated 1 in 1000 men develop epididymitis annually and acute epididymitis accounts for more than 600,000 medical visits per year in the Israel. Epididymitis is the most common cause of intrascrotal inflammation. Incidence is less than 1 case in 1,000 males per year. However, chronic epididymitis may account for up to 80% of patients presenting with scrotal pain in the outpatient setting. In chronic epididymitis, a 4- to 6-week trial of antibiotics for bacterial pathogens, especially against chlamydial infections, is appropriate. When treating epididymitis secondary to C trachomatis or N gonorrhoeae, treatment of all sexual partners is necessary in order to limit the rate of recurrence and to achieve maximal cure rates.