Epididymitis
What is Epididymitis?
Epididymitis is an inflammation of the epididymis, the coiled tube at the back of each testicle that stores and carries sperm. This tube connects your testicle to the vas deferens, which transports sperm to the urethra. When the epididymis becomes inflamed, it causes pain, swelling, and tenderness in the scrotum.
The condition most often affects men between 14 and 35 years old. In younger, sexually active men, epididymitis is usually caused by sexually transmitted infections like chlamydia or gonorrhea. In older men or boys, it may result from urinary tract infections, prostate problems, or structural issues in the urinary system.
Epididymitis can be acute, developing suddenly over one to two days, or chronic, lasting longer than six weeks. Acute cases typically respond well to treatment when caught early. Chronic epididymitis may cause ongoing discomfort and requires a different approach to care.
Symptoms
- Pain and tenderness in the scrotum, usually on one side
- Swelling and redness of the scrotum
- Pain or burning during urination
- Urgent or frequent need to urinate
- Discharge from the penis
- Pain during ejaculation or sexual intercourse
- Blood in the semen
- Discomfort in the lower abdomen or pelvic area
- Fever and chills in severe cases
- A lump or mass in the testicle
Some men experience mild symptoms that develop gradually over several days. Others may have severe pain that comes on suddenly and requires immediate medical attention.
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Causes and risk factors
In sexually active men under 35, epididymitis is most commonly caused by sexually transmitted infections. Chlamydia and gonorrhea are the leading causes in this age group. Trichomonas vaginalis, a parasitic infection, can also trigger inflammation of the epididymis. These infections spread from the urethra or prostate to the epididymis through the vas deferens.
In men over 35 and in boys, bacterial urinary tract infections are the more common cause. Risk factors include urinary catheter use, prostate enlargement, recent urinary tract surgery, and structural abnormalities in the urinary system. Less common causes include mumps, tuberculosis, certain medications, and trauma to the groin area. Men who engage in heavy lifting or straining without proper support may also develop inflammation.
How it's diagnosed
Doctors diagnose epididymitis through a physical exam, medical history, and laboratory tests. Your doctor will examine your scrotum for swelling, tenderness, and lumps. They may also check for enlarged lymph nodes in your groin and discharge from your penis. A rectal exam may be performed to check your prostate.
Testing for sexually transmitted infections is essential for accurate diagnosis. Rite Aid offers testing for chlamydia, gonorrhea, and trichomonas at Quest Diagnostics locations nationwide. These tests use urine or urogenital samples to detect the specific infections that cause epididymitis in younger men. Your doctor may also order a urine culture to check for urinary tract infections or an ultrasound to rule out testicular torsion, a medical emergency.
Treatment options
- Antibiotics to treat bacterial or sexually transmitted infections, typically for 10 to 14 days
- Rest and elevation of the scrotum to reduce swelling and pain
- Ice packs applied to the scrotum for 15 to 20 minutes at a time
- Over-the-counter pain relievers like ibuprofen or acetaminophen
- Avoiding heavy lifting, strenuous exercise, and sexual activity during treatment
- Wearing supportive underwear or an athletic supporter
- Staying hydrated and avoiding alcohol and caffeine, which can irritate the bladder
- Sexual partners should be tested and treated if a sexually transmitted infection is identified
- Follow-up appointments to ensure the infection has cleared
- Surgery in rare cases where abscesses develop or chronic pain persists
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- Simple blood draw at your nearest lab
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Frequently asked questions
Sexually transmitted infections are the leading cause of epididymitis in men under 35. Chlamydia and gonorrhea account for most cases in this age group. These infections spread from the urethra to the epididymis, causing inflammation and pain. Getting tested and treated early prevents complications and protects your sexual partners.
Most men feel better within two to three days of starting antibiotics. Complete healing typically takes one to two weeks with proper treatment and rest. Chronic epididymitis can last six weeks or longer and may require extended treatment. Following your doctor's instructions and avoiding physical strain helps speed recovery.
Untreated or recurrent epididymitis can damage the epididymis and affect sperm production or transport. This may lead to reduced fertility or infertility over time. Getting prompt treatment and completing the full course of antibiotics reduces this risk. If both sides are affected, the risk of fertility problems increases.
Epididymitis itself is not a sexually transmitted disease, but it is often caused by one. In sexually active men under 35, chlamydia and gonorrhea are the most common triggers. In older men and boys, urinary tract infections or other non-sexual causes are more likely. Testing helps identify the specific cause and guides proper treatment.
Both conditions cause severe testicular pain, but testicular torsion is a medical emergency requiring immediate surgery. Torsion pain comes on suddenly and severely, often with nausea and vomiting. Epididymitis pain usually develops gradually over days and may include urinary symptoms or discharge. Any sudden, severe testicular pain requires emergency medical evaluation.
You should avoid all sexual activity until you complete your antibiotics and your symptoms resolve. Having sex during treatment can spread the infection to your partner and slow your recovery. If your epididymitis was caused by a sexually transmitted infection, your partner needs testing and treatment before you resume sexual activity.
Nucleic acid amplification tests detect chlamydia, gonorrhea, and trichomonas infections that commonly cause epididymitis. These tests use a urine sample or urogenital swab to identify the genetic material of the bacteria or parasite. Rite Aid offers these tests as add-ons at Quest Diagnostics locations. Results are typically available within a few days.
Epididymitis requires antibiotic treatment to clear the infection and prevent complications. Without treatment, the infection can spread to the testicle, form an abscess, or become chronic. Untreated sexually transmitted infections can also lead to permanent damage and infertility. Early treatment prevents these serious outcomes and relieves symptoms quickly.
Practicing safe sex with condoms reduces your risk of sexually transmitted infections that cause epididymitis. Getting tested regularly if you are sexually active helps catch infections early. Treating urinary tract infections promptly and avoiding urinary catheters when possible also helps. Wearing protective support during heavy lifting or sports can prevent trauma-related cases.
Epididymitis can recur if the initial infection was not fully treated or if you are re-exposed to the infection. Completing the full course of antibiotics and ensuring your sexual partners are treated prevents reinfection. Some men develop chronic epididymitis with recurring symptoms that require ongoing management. Follow-up testing confirms the infection has cleared.