Epididymitis

Source: Wikipedia, the free encyclopedia.
Epididymitis
Other namesInflammation of the epididymis
Frequency600,000 per year (age 15-35, US)[2]

Epididymitis is a medical condition characterized by inflammation of the epididymis, a curved structure at the back of the testicle.[1] Onset of pain is typically over a day or two.[1] The pain may improve with raising the testicle.[1] Other symptoms may include swelling of the testicle, burning with urination, or frequent urination.[1] Inflammation of the testicle is commonly also present.[1]

In those who are young and sexually active,

Ultrasound can be useful if the diagnosis is unclear.[1]

Treatment may include

antibiotics in those who are young and sexually active are ceftriaxone and doxycycline.[1] Among those who are older, ofloxacin may be used.[1] Complications include infertility and chronic pain.[1] People aged 15 to 35 are most commonly affected, with about 600,000 people within this age group affected per year in the United States.[2]

Signs and symptoms

Adult human testicle with epididymis: A. Head of epididymis, B. Body of epididymis, C. Tail of epididymis, and D. Vas deferens

Those aged 15 to 35 are most commonly affected.[2] The acute form usually develops over the course of several days, with pain and swelling frequently in only one testis, which will hang low in the scrotum.[3] There will often be a recent history of dysuria or urethral discharge.[3] Fever is also a common symptom. In the chronic version, the patient may have painful point tenderness but may or may not have an irregular epididymis upon palpation, though palpation may reveal an indurated epididymis. A scrotal ultrasound may reveal problems with the epididymis, but such an ultrasound may also show nothing unusual. The majority of patients who present with chronic epididymitis have had symptoms for over five years.[4]: p.311 

Complications

Untreated, acute epididymitis's major complications are

organ or system of the body. Chronic pain is also an associated complication for untreated chronic epididymitis.[5]

Causes

Though urinary tract infections in men are rare, bacterial infection is the most common cause of acute epididymitis.

urinary and reproductive structures to the epididymis. In rare circumstances, the infection reaches the epididymis via the bloodstream.[7]

In sexually active men,

men who have sex with men. In the majority of cases in which bacteria are the cause, only one side of the scrotum or the other is the locus of pain.[9]

Non-infectious causes are also possible. Reflux of sterile urine (urine without bacteria) through the

adenovirus or Mycoplasma pneumoniae. Rare non-infectious causes of chronic epididymitis include sarcoidosis (more prevalent in black men) and Behçet's disease.[4]
: p.311 

Any form of epididymitis can be caused by genito-urinary

Congestive epididymitis is a long-term complication of vasectomy.[10][11] Chemical epididymitis may also result from drugs such as amiodarone.[12]

Diagnosis

Doppler ultrasound
of epididymitis, seen as a substantial increase in blood flow in the left epididymis (top image), while it is normal in the right (bottom image). The thickness of the epididymis (between yellow crosses) is only slightly increased.

Diagnosis is typically based on symptoms.

Ultrasound can be useful if the diagnosis is unclear.[1]

Epididymitis usually has a gradual onset. Typical findings are redness, warmth and swelling of the scrotum, with tenderness behind the testicle, away from the middle (this is the normal position of the epididymis relative to the testicle). The cremasteric reflex (elevation of the testicle in response to stroking the upper inner thigh) remains normal.[1] This is a useful sign to distinguish it from testicular torsion. If there is pain relieved by elevation of the testicle, this is called Prehn's sign, which is, however, non-specific and is not useful for diagnosis.[13] Before the advent of sophisticated

Doppler ultrasound is a common test: it can demonstrate areas of blood flow and can distinguish clearly between epididymitis and torsion. However, as torsion and other sources of testicular pain can often be determined by palpation alone, some studies have suggested that the only real benefit of an ultrasound is to assure the person that they do not have testicular cancer.[14]: p.237  Nuclear testicular blood flow testing is rarely used.[citation needed
]

Additional tests may be necessary to identify underlying causes. In younger children, a urinary tract anomaly is frequently found. In sexually active men, tests for

nucleic acid amplification tests (to amplify and detect microbial DNA or other nucleic acids) or tests for syphilis and HIV
.

Classification

Histopathology image of inflamed epididymis and testis

Epididymitis can be classified as acute, subacute, and chronic, depending on the duration of symptoms.[6]

Chronic epididymitis

Scrotal ultrasound showing calcifications and cysts in a case of chronic epididymis.

Chronic epididymitis is epididymitis that is present for more than 3 months. Chronic epididymitis is characterized by inflammation even when there is no infection present. Tests are needed to distinguish chronic epididymitis from a range of other disorders that can cause constant scrotal pain including testicular cancer (though this is often painless), enlarged scrotal veins (varicocele), calcifications,[15] and a possible cyst within the epididymis. Some research has found that as much as 80% of visits to a urologist for scrotal pain are for chronic epididymitis.[4]: p.311  As a further complication, the nerves in the scrotal area are closely connected to those of the abdomen, sometimes causing abdominal pain similar to a hernia (see referred pain).

Chronic epididymitis is most commonly associated with lower back pain, and the onset of pain often co-occurs with activity that stresses the low back (i.e., heavy lifting, long periods of car driving, poor posture while sitting, or any other activity that interferes with the normal curve of the

lumbar lordosis region).[14]
: p.237 

Treatment

In both the acute and chronic forms,

Fluoroquinolones are no longer recommended due to widespread resistance of gonorrhoeae to this class.[8] Doxycycline
may be used as an alternative to azithromycin. In chronic epididymitis, a four- to six-week course of antibiotics may be prescribed to ensure the complete eradication of any possible bacterial cause, especially the various chlamydiae.

For cases caused by enteric organisms (such as E. coli), ofloxacin or levofloxacin are recommended.[8]

In children, fluoroquinolones and doxycycline are best avoided. Since bacteria that cause urinary tract infections are often the cause of epididymitis in children,

cephalexin) can be used.[citation needed
]

Household remedies such as elevation of the

epididymectomy may be required. In cases with unrelenting testicular pain, removal of the entire testicle—orchiectomy
—may also be warranted.

It is generally believed that most cases of chronic epididymitis will eventually "burn out" of patient's system if left untreated, though this might take years or even decades.[5] However, some prostate-related medications have proven effective in treating chronic epididymitis, including doxazosin.[16]

Epidemiology

Epididymitis makes up 1 in 144 visits for medical care (0.69 percent) in men 18 to 50 years old or 600,000 cases in males between 18 and 35 in the United States.[6]

It occurs primarily in those 16 to 30 years of age and 51 to 70 years.

chlamydia and gonorrhea.[8]

References

Further reading

External links