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Epididymitis - Causes, Symptoms and Treatment

What is Epididymitis?

This infection of the epididymis, the testicle's cord like excretory duct, is one of the most common infections of the male reproductive tract. It usually affects adults and is rare before puberty. Epididymitis may spread to the testicle itself, causing orchitis; bilateral epididymitis may cause sterility.

What are the Causes of Epididymitis?

Epididymitis usually results from pyogenic organisms, such as Enterobacteriaceae and Pseudomonas. Epididymitis can result from an existing urinary tract infection or prostatitis and reach the epididymis through the lumen of the vas deferens.

Rarely, epididymitis is secondary to a distant infection, such as pharyngitis or tuberculosis, that spreads through the lymphatics or, less commonly, the blood-stream.

Other causes include trauma, gonorrhea, syphilis, and a chlamydial infection. Trauma may reactivate a dormant infection or initiate a new one. Epididymitis is a complication of prostatectomy and may also result from chemical irritation by extravasation of urine through the vas deferens.

What are the Signs and Symptoms of Epididymitis?

The key symptoms are pain, extreme tenderness, and swelling in the groin and scrotum. Other clinical effects include high fever, malaise, and a characteristic waddle-an attempt to protect the groin and scrotum during walking. Symptoms of a urinary tract infection may also be present. An acute hydrocele may also occur as a reaction to the inflammatory process.

Diagnosis for Epididymitis

Clinical features suggest epididymitis, but the actual diagnosis is made with the aid of the following laboratory tests:

1. Urinalysis shows an increased white blood cell (WBC) count, indicating infection.

2. Urine culture and sensitivity tests may identify the causative microbe.

3. Scrotal ultrasonography may help differentiate acute epididymitis from other conditions such as testicular torsion, a surgical emergency.

Treatment for Epididymitis

The goal of treatment is to reduce pain and swelling and combat infection. Therapy must begin immediately, particularly in the patient with bilateral epididymitis, because sterility is always a threat. Some of the treatment options are given below:

  • During the acute phase, treatment consists of bed rest, scrotal elevation with towel rolls or adhesive strapping, broad-spectrum antibiotics, and analgesics.
  • An ice bag applied to the area may reduce swelling and relieve pain. (Heat is contraindicated because it may damage germinal cells, which are viable only at or below normal body temperature.)
  • When pain and swelling subside and allow walking, an athletic supporter may prevent pain.
  • Occasionally, corticosteroids may be prescribed to help counteract inflammation, but their use is controversial.

Special Considerations and Prevention Tips for Epididymitis

1. Watch closely for abscess formation (a localized hot, red, tender area) and extension of the infection into the testes. Closely monitor temperature, and ensure adequate fluid intake.

2. Because the patient is usually uncomfortable, administer analgesics as necessary. During bed rest, check often for proper scrotum elevation.

3. Before discharge, emphasize the importance of completing the prescribed antibiotic therapy, even after symptoms subside.

4. If the patient faces the possibility of sterility, suggest supportive counseling, as necessary.

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