Testicle Infection (Epididymitis)

Epididymitis is inflammation or infection of the epididymis that is usually caused by a bacterial infection. Testicle infection is the most common reason for inflammation in the scrotum.

• The epididymis is a firm tube that lies on the back surface of a man’s testicle. It is coiled in order to fit a length of nearly 20 feet into a small space. This long length acts as a storage space for the sperm and gives them time to mature.

• The epididymis can be divided into 3 sections: the head (an expanded upper end), the body, and the pointed tail.

• The epididymis also absorbs fluid and adds substances to help nourish the maturing sperm.

The cause of epididymitis is usually a bacterial infection. The bacteria usually get to the epididymis by moving back through the urethra (urine passes through the urethra from the bladder). The exact bacteria are identified in about 80% of cases.

Two main groups of organisms cause epididymitis: sexually transmitted organisms and coliforms (organisms that live in the intestines).

• In men younger than 35 years, the causes are usually the same organisms that cause the sexually transmitted diseases of chlamydia (responsible for nearly 50-60% of cases) and gonorrhea.

• In those older than 35 years and men who participate in anal intercourse, the causes are usually coliforms, which are bacteria (such as Escherichia coli) that live in the intestines. These organisms also cause bladder infections.

• Chemical epididymitis (rare) is inflammation caused by the backward flow of urine when exercising or having sex with a full bladder.

Symptoms start gradually and often peak within 24 hours. Pain usually begins in the scrotum or groin.

• Abdominal or flank pain: At first, inflammation begins in the vas deferens (which is the duct that carries sperm to the urethra) and then descends to the epididymis. This descent explains why symptoms can start initially in the flank (your lower back) and groin.

• Scrotal pain and swelling: The epididymis swells to often twice normal size within 3-4 hours (the degree of swelling is variable).

• Pain on urination

• Discharge from your urethra (at the end of your penis; especially in men younger than 35 years)

• Fever and chills

• Nausea

Mild scrotal pain, urinary symptoms, or any of the other symptoms of epididymitis suggest a visit to your health care provider because the treatment for epididymitis is an antibiotic. If the doctor is concerned about complications or an alternative diagnosis, you will likely be sent to a hospital for further tests. If you have scrotal pain or urinary symptoms and cannot be seen by your health care provider (or if you do not have one), then you should go to a hospital’s emergency department. Symptoms that require urgent care include these:

• Severe scrotal pain: This could represent testicular torsion, which is a very serious disease that needs immediate attention. The outcome for this particular diagnosis is time dependent. The faster you get treatment, the less damage may be done. Seek care immediately.

• Urinary symptoms

• Discharge from your penis

• Pain or burning with urination

• Urinary frequency (more often than normal)

• Fever and chills

• Nausea

• Abdominal or flank pain

Your health care provider will take a detailed history (including a sexual history), collect a urine sample, and perform a physical examination.

• Urinalysis and urine culture: These tests aid in the diagnosis of a urinary tract infection (bladder infection).

• Urethral culture

• Your urine can be tested for sexually transmitted diseases present in the urethra.

• Sometimes a swab is inserted about one-half inch into the urethra and sent for testing (although uncomfortable, it only takes a few seconds).

• The results usually take more than a day to come back.

• The doctor may or may not decide to test your blood. Your white blood cell count may be high if infection is present.

The doctor likely will treat you with antibiotics through an IV, a shot, or pills by mouth (to be taken for 10 days or longer).   

• In men younger than 35 years

• Ceftriaxone (Rocephin) - As a single dose either in a shot or through an IV line

• Doxycycline (Vibramycin) - Pills twice a day for 10 days in addition to the shot of Ceftriaxone

• Ofloxacin (Floxin) - Pills twice a day for 10 days (an alternative treatment)

• In men older than 35 years or those who participate in anal intercourse

• Ciprofloxacin (Cipro) - Pills twice a day for 10-14 days

• Ofloxacin (Floxin) - Pills twice a day for 10-14 days

• Co-trimoxazole (Bactrim DS [double strength]) - Pills twice a day for 10-14 days

Follow up with your health care provider to ensure that the antibiotics are working.  

• If you are not responding to antibiotics, you may need an ultrasound (ordered by the doctor or urologist, who is a specialist in genital conditions). This is an imaging procedure to check your genital area.
  
  
• Make sure your condition doesn’t progress to become orchitis, an infection of the tube that carries semen out of 1 or both testicles. This is called epididymo-orchitis. Orchitis can result from the spread of bacteria through the blood from other locations in your body.
  
  
• A testicular tumor may be present. An ultrasound or blood test might be needed.

For men younger than 35 years, the cause is usually sexually related diseases. If one partner is infected, the other partner should be evaluated and potentially treated as well. Otherwise, you may become reinfected.

• Abstinence (no sexual relations)

• Condom use

• Single partner

If treated appropriately with antibiotics, your infection should clear up.

• Pain improves within 1-3 days.

• Swelling may take several weeks to go away.

• Complications are possible.

• Sterility: If the epididymitis involves both sides and is untreated, sterility may result (rarely, sterility can still occur even with antibiotic treatment).

• Scrotal abscess (an infection)

• Co-infection of the testicle (epididymo-orchitis)

• Sepsis (spread of infection into the bloodstream)

• Fournier gangrene (a severe and life-threatening infection of the scrotal area that kills the cells)

MEDLINEplus, Testicular infection or torsion 

MEDLINEplus, Testicle lump

epididymitis, infection of the epididymis, testicle infection, scrotum infection, orchitis