Introduction
Epididymitis is frequently confused with orchitis, which is a testicular inflammation. A noticeable ridge is felt below the testes when the testis is gripped between the fingers; this is the epididymis, and epididymitis is inflammation of this microtubular structure. Epididymitis is divided into three categories based on how long it lasts: subacute, acute, and chronic.
Why Is Epididymis Important?
The testis produces sperm, which travel through microscopic tubes to the epididymis, where they are deposited. Chemicals produced in the epididymis improve their ability to move. The immature sperm generated in the testis are incapable of fertilization.
What Is Acute Epididymitis?
Acute refers to a condition that lasts fewer than four weeks. Severe pain is a defining feature of acute illness. Acute epididymitis necessitates immediate medical attention as it can progress to chronic epididymitis. A bacterial infection is the most common cause of acute epididymitis.
What Is Chronic Epididymitis?
Chronic refers to a condition that persists for more than four weeks. Low-grade pain in the testicle characterizes this illness, which eventually spreads to other parts of the reproductive gland.
What Causes Epididymitis?
Bacteria and non-bacterial causes can both induce epididymitis.
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Sexually transmitted diseases such as gonorrhea and chlamydia can cause bacterial infection.
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Urinary tract infections can also induce the condition.
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Direct trauma to the groin region.
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Renal problems can cause epididymitis by the inward flow of urine. This condition is called chemical epididymitis.
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Epididymitis is also seen in patients who have undergone surgical procedures such as prostatectomy.
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Some viral infections such as herpes are also proven to cause the condition.
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Tuberculosis
What Are Some of the Risk Factors for Epididymitis?
Risk factors are those whose presence is likely to increase the possibility of the disease. The risk factors for epididymitis are listed below:
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Unprotected sex, especially anal sex, eventually leads to sexually transmitted infections.
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A recent episode of a urinary tract infection.
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Presence of obstructive diseases such as Behcet syndrome and sarcoidosis.
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Trauma from strenuous activity such as weight lifting and bicycling.
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Prior case of inguinal hernia.
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Presence of immunosuppressive diseases such as AIDS (acquired immunodeficiency virus).
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On amiodarone medication.
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Incomplete circumcision.
Can Children Get Epididymitis?
Yes, children are equally prone to get epididymitis as adults, but the cause for the occurrence is different. It is usually trauma, urinary tract infection, urinary reflex, and torsion of the epididymis. Whereas in adults, it is primarily the sexual causes.
What Are the Signs and Symptoms of Epididymitis?
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Testicular pain of varying intensity.
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Unilateral pain on the touch (tenderness) in the testicles.
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Painful urination.
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Decreased urination.
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Unable to control bladder movements.
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Lower abdominal pain.
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Unusual penile discharge.
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Blood in seminal discharge.
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Redness in the scrotal area.
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Chills.
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Pain during intercourse.
What Tests Are Usually Done to Diagnose Epididymitis?
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Physical examination-physical assessment includes the
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Assessment of epididymis for pain and swelling.
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Inspection of the scrotum for pain and swelling.
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Assessment of temperature.
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Signs- the doctor also checks for particular signs indicative of the condition, such as:
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Prehn sign- Pain relieves when the testicles are elevated.
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Blue dot sign- A blue dot is seen in the scrotum representing the torsion of the appendix testis.
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Urine test- combined tests for gonorrhea and chlamydia are done if any unusual discharge is absent.
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Swab test- if an unusual penile discharge is current, a swab test is done for gonorrhea and chlamydia.
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Urine culture- urine culture is advised if the urine dipstick test is positive or negative for specific elements.
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Ultrasound and doppler tests are done if the condition appears to be such severe as torsion.
How Is Epididymitis Treated?
The patient is advised to take bed rest, and the following is done to treat epididymitis:
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Specific antibiotics are administered.
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Scrotal elevation.
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Analgesics and non-steroidal anti-inflammatory drugs are prescribed to reduce pain and swelling.
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If the patient appears with toxic symptoms, then hospital administration is necessary.
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Patients with co-morbidities and immunosuppressed conditions are additionally considered.
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Change in the prescription if the patient is on amiodarone medication.
How Long Does It Take To Overcome Epididymitis?
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If epididymitis is acute and specific antibiotics are administered, it will likely resolve epididymitis in two weeks.
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If the epididymitis is bilateral(infected epididymis on both sides), then the infection can last up to six weeks.
Why Should a Woman Get Tested if Her Spouse Is Diagnosed With Epididymitis?
Females do not have epididymis; hence they cannot be infected with epididymitis. Women should get tested for gonorrheal and chlamydia infections, as the most typical cause of epididymitis is STIs(sexually transmitted diseases).
What Happens if Epididymitis Is Left Untreated?
The potential complications of untreated epididymitis include:
Infertility- The job of the epididymis is to convert the immature sperms to mature sperms with increased motility and store them.
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Epididymitis can cause blockage of the tube, which in turn blocks the transfer of the sperm leading to infertility.
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Epididymitis can restrict the vascular supply that can cause infertility by testicular infarction.
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Also affects the quality of sperm.
Testicular Abscess- if the infection spreads from the epididymis to the scrotal region, it can cause a testicular abscess (pus-filled lesion).
Chronic Epididymitis-If acute epididymitis is left untreated, it can lead to chronic epididymitis.
Sepsis - can occur as a sequence of infections.
How to Prevent Epididymitis?
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Epididymitis can be prevented by:
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Avoiding unprotected anal sex.
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Limiting the number of sexual partners.
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Getting vaccinated for tuberculosis.
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Getting screened for STIs(sexually transmitted infections) biannually.
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Circumcision of the penis also reduces the risk of infection.
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Scrotal and testicular pain should not be ignored as it could indicate a medical emergency.
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Maintaining personal hygiene to avoid UTIs (urinary tract infections).
Conclusion
Epididymitis is a curable and preventative condition, but it's complicated because it has several differential diagnoses. Testicular torsion, for example, has identical symptoms and should be treated as soon as possible. As a result, ignoring scrotal and testicular pain is not recommended. Epididymitis can be confused with many other dangerous disorders.
