Epididymitis – Diagnosis and Treatment
Diagnosis
Doctors begin checking for epididymitis by asking about the patient’s symptoms, such as pain, swelling, and fever. They carefully examine the groin for tenderness or an enlarged testicle.
A physical exam may also include checking for swollen lymph nodes and sometimes a rectal exam to see if the prostate is enlarged or sore.
Doctors use these tests and procedures:
- Urine and Blood Tests: Doctors use urinalysis or urine culture to check for a urinary tract infection, bacterial epididymitis, or signs of urethritis.
- Sexually Transmitted Infection (STI) Tests: Using a swab from the urethra, doctors test for diseases like chlamydia and gonorrhea.
- Ultrasound Imaging: This test uses sound waves to produce detailed images of the testicles and surrounding areas. It helps doctors distinguish epididymitis from testicular torsion, which cuts off blood flow. If an ultrasound shows normal or increased blood flow, doctors diagnose epididymitis. Decreased blood flow often indicates testicular torsion instead.
Doctors use these steps to separate acute epididymitis from other problems, such as epididymo-orchitis or chronic cases.
Treatment
Medicine to Fight Bacteria
When bacteria such as Chlamydia trachomatis or Neisseria gonorrhoeae cause epididymitis, doctors prescribe antibiotics as the main treatment.
This typically involves a combination of a cephalosporin injection and a tetracycline antibiotic taken by mouth, or sometimes a fluoroquinolone antibiotic if needed.
Patients should complete the full course of antibiotics, even after symptoms begin to improve. If a sexually transmitted infection caused the condition, doctors recommend that sexual partners also receive treatment to prevent reinfection.
| Antibiotic | Typical Use |
|---|---|
| Cephalosporin (Injection) | Gonorrhea, chlamydia |
| Tetracycline Antibiotic | Chlamydia; alternate for gonorrhea |
| Fluoroquinolone Antibiotic | Other bacterial infections |
Relief and Supportive Care
Patients can manage discomfort and swelling at home. Resting in bed, wearing supportive underwear, and using ice packs help reduce swelling and pain.
Over-the-counter pain relievers, such as ibuprofen or other NSAIDs (nonsteroidal anti-inflammatory drugs), relieve pain.
Symptoms often start to improve in a few days, but full recovery may take several weeks. Doctors may schedule follow-up visits to make sure the infection has cleared.
- Rest and limit activity.
- Support the scrotum.
- Apply ice packs.
- Take pain medicine as advised.
Surgical Procedures
In rare cases, a pocket of pus (abscess) forms, and surgeons drain it. If medicine and comfort steps do not help, or if structural problems exist in the urinary tract, doctors may remove all or part of the epididymis.
This surgery is called an epididymectomy. Doctors consider surgical repairs only when other treatments do not work.
Everyday Care and Tips for Relief
To help manage discomfort and swelling in the scrotum or testicle, people should:
- Get plenty of rest and stay in bed when possible.
- Use a pillow or folded towel to keep the scrotum raised.
- Place a cold pack in the area for short periods.
- Wear snug underwear or an athletic supporter.
- Avoid heavy lifting or any strenuous activity.
- Hold off on sex until the infection is completely gone.
Practicing safe sex, such as using condoms, can lower the risk of infection and future problems.
Getting Ready for Your Visit
Steps to Take Before Your Visit
Taking some time to prepare can help make the appointment smoother and ensure important details are not missed. Write down any symptoms, when they started, and how severe they are.
Bring a list of all medications, vitamins, and supplements, along with dosages, so the healthcare provider understands the full picture.
Note past health issues, such as prior sexually transmitted diseases (STDs), sexually transmitted infections (STIs), or relevant surgeries, since they can affect the risk of epididymitis. If a child is affected, note any recent injuries or trauma.
Preparing a list of questions helps maximize the visit. Some example questions include:
- What could be causing these symptoms?
- Are more tests or procedures needed?
- What treatments are best for this case?
- Should a partner be checked for an STI?
- Is it necessary to stop sexual activity?
- How does this fit with other health concerns?
- Will follow-up visits be needed, and with which specialist (such as a urologist)?
Bringing this information helps the healthcare provider quickly understand the situation and choose the best plan.
Questions the Doctor Might Ask
The healthcare provider will likely ask several questions to get a clear picture. These can include:
- How severe are the symptoms, and how long have they lasted?
- Has there been aching, swelling, pain during urination, or blood in semen?
- Is there any discharge or signs of a sexually transmitted infection?
- Have there been partners with STIs, or testing for them?
- Any past cases of prostate trouble, urinary infections, or recent trauma to the groin area?
- Has there been recent surgery near the urinary tract, or use of a catheter?
- Is heavy lifting common at work or in hobbies?
- For children, did any accidents or injuries happen recently?
Having answers ready helps the healthcare provider or urologist make the right diagnosis and suggest the best treatment.
