Epididymitis/Orchitis
Epididymitis and orchitis refer to, respectively, infection or inflammation of the epididymis or the testicle. Clinically speaking, the terms are essentially interchangeable, and for the purposes of this piece, they are referred to as one in the same.
Like prostatitis, the acute form of epididymitis is sudden in onset, extreme in symptoms, and readily treatable with antibiotics. The cause is usually a bacterial infection with accompanying swelling, fever, severe pain, and redness of the scrotum. Bodywide symptoms such as fever and muscle aches are common, and particularly severe cases can lead to septic shock.
The bacteria are usually enteric (GI-related) in origin, however, other bacteria such as Chlamydia which are sexually transmitted can also cause episodes of epididymitis.
Antibiotics such as quinolones, sulfa drugs, or doxycycline are used to treat acute epididymitis. An anti-inflammatory such as ibuprofen may also help with symptoms. The acute phase of pain and discomfort usually improves reasonably rapidly (several days), however, low-grade pain from an episode of epididymitis can linger for weeks to months. A useful diagnostic tool is testicular ultrasound, as other testicular problems such as torsion (cutting off of the blood supply because of twisting) or cancer must be excluded. Epididymitis and orchitis, as far as we know, pose no risk or danger to the future development of a testicular malignancy.
Unlike the acute form, chronic epididymitis tends to be less severe in symptomatology with an ill-defined course of onset and improvement. Low to moderate grade pain is the usual presenting symptom, with very little swelling redness or scrotal irritation. The chronic version of this condition can be bacterial in nature as well as inflammatory. Occasionally, epididymitis can also be non-bacterial in nature, as urine from the prostate can be refluxed into the epididymis. Determining the ultimate cause can be quite difficult and often both antibiotics and anti-inflammatories are used.
Patients with chronic testicular and epididymal discomfort are often labeled as having relapsing chronic epididymitis. Treatment regimens take time and patience to perfect, and each person with chronic pain or inflammation is different. It is easy for both patient and physician to get frustrated searching for relief. Other than antibiotics and anti-inflammatories, other treatment regimens may involve pain management, vasectomy to prevent reflux of urine, acupuncture, biofeedback, pelvic floor relaxation, and ultimately removal of the testicle or the epididymis.
It is not uncommon for bouts of epididymitis or pain to relapse even after years of laying in remission. Testicular ultrasound again is a useful tool to help determine bloodflow patterns as well as exclude malignancy as a cause for testicular pain and discomfort.
If you have concerns over testicular pain or think you may have epididymitis, please feel free to consult with one of our physicians.