After taking antibiotics for epididymitis the swelling went but pain remained. Why?

Question

Hello doctor,

I had epididymitis twice two years ago. I was given antibiotics both the times. The swelling went but the testicle (epididymis pain) remained. I was given more antibiotics over the next few months to no effect. I went to a urologist 12 months later and was diagnosed with prostatitis upon examination. I was offered prostate massage but said no due to a worry over the potential negative effects of the procedure. Urine and blood test came back negative for STI and bacteria. The only issue was low testosterone. I had to see a hormone doctor for the second testosterone test. He noticed some atrophy of the testicles, for which I had an ultrasound. I was then told that the testicles are of normal size and there is no sign of damage, infection, etc. Since then, the pain has worsened. The epididymis hurts when touched, and spermatic cord feels hardened. There is pain during and after urination, although there is no swelling in the scrotum or groin. I have not had most of the prostatitis symptoms for months like the frequent urination, burning scrotum, anus, etc. The pain is in the back flank mostly in the epididymis and thigh region. Could it be intermittent torsion?What antibiotics would you prescribe? If antibiotics fail, would a spermatic cord block be the way to go? Could I have infected my epididymis from my prostate through over masturbation (two times daily) and made the pain worse?

Answer 1

Hello,

Welcome to icliniq.com.

As per your history, it does not look like prostatitis. I think you may be suffering from chronic epididymitis. There are many causes for chronic epididymitis like post-acute epididymitis, vas obstruction, drug-induced like Amiodarone, Tuberculous epididymitis, chlamydia epididymitis (non-culturable organism). In a majority of the cases, it is idiopathic without any cause. You had almost every test done. One more test you can get done, which is semen culture and sensitivity. Regarding your questions: No, it is not intermittent torsion as your symptoms are not typical of intermittent torsion. I would prescribe antibiotics based on the semen culture and sensitivity report. Empirically, I would like to give tablet Doxycycline 100 mg twice daily for four weeks. Consult your specialist doctor, discuss with him or her and start taking the medicines with their consent. Spermatic cord block is not a permanent therapy. As you are 28 years, I would not like to advise any surgical intervention as far as possible. Over-masturbation is not a cause of prostatitis or epididymitis.