2017-04-12 / Health Care

Epididymitis – a cause for concern for men

By Dr. David Samadi

There is a long, narrow tube tightly coiled at the back of the testicles called the epididymis. This little-known curved structure is where sperm can mature and be stored. If the epididymis becomes inflamed it is then known as epididymitis. Epididymitis is not a commonly known condition but once a man has it, he probably won’t forget it. Each year more than 60,000 men in the United States will visit an emergency room due to this problem.

Men who are most affected by epididymitis are sexually active men in their 20s and 30s, yet it can strike men of any age and who are celibate. This condition is most often caused by a bacterial infection including sexually transmitted infections such as gonorrhea or chlamydia. When it occurs in children or older men, it is usually caused by E. coli and similar bacteria. A medicine used to prevent abnormal heart rhythms called Amiodarone or Pacerone can be another cause of it. Sometimes trauma to the groin can result in epididymitis or when a man does heavy lifting causing urine to flow backward into the epididymis.

Signs of epididymitis
There can be many signs and symptoms of a man with epididymitis which include:
• Urinary burning and increased frequency
• Penile discharge
• A swollen, red or warm scrotum
• Testicle pain and tenderness, usually on one side
• A fever
• Painful intercourse or ejaculation
• A lump on the testicle
• Pain or discomfort in the lower abdomen
• Blood in the semen

Getting epididymitis diagnosed

Anytime a man has scrotal pain or swelling, or discharge from his penis or pain when urinating, he needs to see his doctor. There are a number of reasons for scrotal pain, and in order to prevent permanent damage, it needs to be checked out as soon as possible.

When the pain is severe, go to the emergency room right away. A doctor will do a physical exam, checking for enlarged lymph nodes in the groin area and may do a rectal exam to check for prostate enlargement. Blood and urine samples will be analyzed for abnormalities and an ultrasound may be used to rule out testicular torsion.

In addition, a doctor may also want to do a screening for a sexually transmitted disease by inserting a narrow swab into the end of the penis to obtain a sample of discharge from the urethra. This sample will be sent off to a lab to be tested for the sexually transmitted diseases of gonorrhea and chlamydia.

Treatment for epididymitis

Once epididymitis is diagnosed, men often require bed rest with a scrotal support for comfort. Antibiotics will be prescribed along with non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen or naproxen. The entire course of the antibiotic prescribed needs to be taken to completely eliminate the bacteria. If the cause of the infection is due to a sexually transmitted infection, a man’s sexual partner will need to be treated also.

It may take several weeks for tenderness in the groin area to completely disappear. It is important for men to rest, wear an athletic strap to support the scrotum, apply ice packs and take pain medications to relieve discomfort.

A follow-up visit with a man’s doctor is recommended to make sure the infection has completely cleared up. Most men will have epididymitis clear up within three months with no longterm sexual or reproductive problems.

Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital. He is a medical correspondent for the Fox News Channel's Medical A-Team. Follow Dr. Samadi on Twitter, Instagram, Pintrest, SamadiMD.com and Facebook

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