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Epididymitis:
Epididymitis is inflammation of tube /coil that carries sperm from testicle out. While there are many contributing factors, I will try to explain the main causes which are mainly related to Sexually transmitted diseases. Patient often get confused of understanding epididymitis so I designed plan the 3D anatomical photo to make it easier to visualize this condition.
following are the STD related causes:
Epididymitis by Gonococcal Urethritis
Neisseria Gonorrhea is a bacterial infection that we get contracted by sexual contact (oral, anal, vaginal), once this bacteria infect the urethra and patient develop urethritis then he must get evaluated and treated asap. Failure to do so, will provide opportunity that the bacteria move from urethra in penile to vas difference tube (sperm tube) and down toward testicles. Prior to reach testicles will infect the coil and tubes on top of testicles called epididymis. Patient symptom will change from urethral and urinary discomfort to pain and possible swelling around testicle. At this time just to treat the patient urethritis or gonorrhea might not be sufficient to cure or relive the patient disease.
Epididymitis by NGU
It is stand for Non-Gonococcal urethritis. It is the inflammation of urethra by other causes than gonorrhea. It could be chlamydia or may not be. The proportion of NGU cases caused by chlamydia has been declining gradually, so NGU must be considered on evaluation of high risk patient or symptomatic patients with epididymitis. Similar to gonorrhea, The bacteria and viruses from NGU will travel down to epididymis and cause epididymitis the way I explained on previous paragraph in Gonorrhea.
Chlamydia trachomatis (CT) |
15% to 40% |
Ureaplasma urealyticum (UU) |
10% to 40% |
Neither |
20% to 40% |
Mycoplasma genitalium |
15% to 25% |
Trichomonas vaginalis (TV) |
up to 13% |
Herpes Simplex Virus (HSV) |
< 5% |
Candida albicans |
<1% |
Miscellaneous bacteria |
<1% |
Other (E.Coli, Haemophilus spp gram positive organisms) |
? |
Unknown |
20-30% |
"Adapted from Holmes KK et al. Sexually Transmitted Diseases. 3rd ED. 1999. ch. 60, page 834"
Epididymitis by Trichomonas:
Trichomonas is a parasite and sexually transmitted disease. It is more common with female than men. Female with with multiple sexual partners or with male with multiple sexual partners are at higher risk.
This may lead to unusual case of epididymitis.
Symptom:
Swelling on scrotum
Warmness
Pain
discomfort upon walking when scrotum touches legs
pain upon jumping up and down
lower abdominal pain
Pain upon sex
Pain upon ejaculation
Pain upon palpating testicles or its surrounding
Diagnosis:
There is no specific test that you could do for diagnosis of epididymitis. It is upon doctor examination and his experience to come up with this particular diagnosis.
Doctor has to keep sexually transmitted infectious diseases on his top of his list when evaluating , diagnosing and treating epididymitis. To my experience urethral swab analysis must be part of testing to eliminate urethritis as contributing factor to epididymitis. Clinician has to make sure if patient has urethral infection. As I explained before untreated Gonorrhea or NGU could lead to epididymitis.
If patient has symptom and clinician just test for Gonorrhea and Chlamydia then he would miss other causative etiology (other bacterial or viral infection )
Treatment
The successful treatment is the one chosen wisely based on diagnosis. Each bacterial infection has its own treatment. There are guideline for treating epididymitis based on common type of infection, but good clinician always investigate and treat accordingly.
For example if epididymitis related to Trichomonas then patient may need anti-parasite and not just routine antibiotics. In other instances, if it is related to chemical or trauma then medicine might not work. Bottom line, Diagnosis first then treatment comes second.
Epididymitis in Married Men
I am going to touch important topic here as I am sure is matter of concern and questions for many patients. The typical scenario is a 45 year old married man presenting with clinical diagnosis of epididymitis. Clinician should be in search of what would be the reason of epididymitis specially if patient is monogamous and possible risk of STD is low. I would eliminate the urethritis (inflammation of urethra) first In this case, and if non-infectious etiology is ruled out then physician should consider to recommend partner (wife) to be evaluated for Bacterial Vaginosis and Trichomoniasis. for Our Bacterial Vaginosis information page please click here.
We do know that you do not get urethritis from bedding, toilet seats, swimming pools, or from touching objects. It is usually sex related disease.
Orchitis
It stands for inflammation of testicle, It could be infectious or non-infectious . Many elements that contribute to epididymitis would also lead to orchitis. Untreated orchitis may lead infertility. Pain and symptom may subsided by treatment, but it may take days or weeks to discomfort resolve. It takes longer to inflammation resolve after infection clear and inflammation is the main contributor of the stimulation pain perception pathway. It might be beneficial that you get re-tested again to make sure that your STI or urethritis has been resolved if you continue to have symptom.
 
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