Definition

Epididymitis is an inflammation of the epididymis, a part of the urinary and reproductive system. In men, the epididymis is a tube attached to the back of the testicles and functions to carry mature sperm. Swelling in the epididymis can cause pain in both testicles.

Epididymitis can occur in men of all ages, although it is most common in the 14-35 age range. Approximately 600,000 men suffer from the disease each year in the United States. Because the epididymis is close to the testicles, sometimes the testicles can also become infected. This condition is known as epididymal orchitis.

Causes

Epididymitis is most often caused by bacterial infection. In men aged 20-39 years, most cases are associated with sexually transmitted infections such as gonorrhea and chlamydia. Meanwhile, in men over the age of 39, most of the bacteria that cause epididymitis are Escherichia coli and other bacteria often found in the digestive tract.

Other infections that can also cause inflammation of the epididymis are microbes from urinary tract infections, prostate infections, or tuberculosis. These bacteria and microbes can spread from the urinary tract or other parts of the body, then infect the epididymis and make it inflamed.

In addition to infection, there are other things that can cause epididymitis, namely:

• Injury to the epididymis or groin
• Sports with repetitive movements such as running, jumping, lifting weights
• Viral infections
• The effects of certain drugs
• There is a blockage in the urine outlet (urethra)
• Enlarged prostate gland
• Use of a urine tube (catheter)

Risk factor

There are several factors that are thought to increase the risk of men experiencing epididymitis, including:

• Uncircumcised penis
• Unprotected sex
• Abnormalities in the structure of the urinary tract
• Tuberculosis
•  History of surgery on the prostate, urethra, or bladder
• History of injury to the groin area
• Using a urine tube
• Have a heart rhythm disorder and using the drug amiodarone

Symptoms

Epididymitis may begin with mild symptoms, but if left untreated, these symptoms can worsen significantly. The symptoms associated with epididymitis include:

• Pain and swelling in the scrotum
• Feel worse over time
• Spread from the pelvis to the scrotum
• Pain when urinating
• Urination becomes frequent
• Can come out of fluid other than urine or semen from the penis
• Testicles are swollen and red
• Fever chills with a temperature that is not too high
• Lymph nodes in the groin area can be enlarged
• Pain during sexual intercourse

Diagnosis

Doctors typically diagnose diseases by conducting medical interviews, performing physical examinations, and, if necessary, using supplementary tests.

Medical Interview

The doctor will ask about the patient's current complaints, medical history, and how active the patient was before the disease appeared. You also need to tell them about the medicines you are taking to treat your complaints or the medicines you take regularly.

Physical Examination

During the physical examination, the doctor will examine the patient according to the symptoms felt by the patient so that several clinical signs can be found that direct the doctor to a particular disease. In cases of epididymitis, the scrotum is usually swollen and painful when pressed. The skin of the scrotum can also feel warm and look red.

The doctor can also feel for swelling in the lymph nodes in the groin area or the presence of discharge on the penis. If there are complaints of urination, the doctor can examine the anus and rectum to assess if the prostate gland is enlarged or infected.

Supporting Examination

Supporting examinations also play a role in establishing or confirming the diagnosis of epididymitis.

• A complete blood count can help determine if there is an infection or anemia in the patient's body.
• A complete urine test can be done to see if there is a bacterial infection and red blood cells in the urine.
• A sample of the discharge from the penis can also be taken for laboratory examination to find out if there are signs of a sexually transmitted infection.
• In some cases of epididymitis, an ultrasound examination can be used to assess and take diagnostic images of the scrotum area.
• A CT scan can also be done if the doctor suspects other diseases that accompany epididymitis, such as urinary tract stones

Management

Treatment for epididymitis focuses on addressing the underlying infection and relieving the patient's symptoms. Doctors may prescribe antibiotics to treat bacterial infections and pain relievers to manage pain. It is essential for patients to complete the entire course of antibiotics as prescribed.

In addition to the prescribed medications, you can also alleviate inflammation at home by

• Reduce swelling with ice compresses regularly
• Get complete rest and avoid heavy activity
• Elevate the scrotum or scrotum for at least 2 days if possible

If epididymitis occurs due to a sexually transmitted infection, the patient and sexual partner need to refrain from having sex until treatment is complete and declared cured.

Complications

Generally, most cases of epididymitis can be cured after being given antibiotics. However, the infection can recur in the future. Complications can arise if epididymitis is not treated correctly, such as:

• Chronic epididymitis (long-term)
• Formation of an abscess or pus pocket in the epididymis
• If the infection spreads to the bloodstream, sepsis or organ failure can occur
• Epididymitis that occurs in both epididymis can cause a person to become sterile

Prevention

It is sometimes difficult to prevent epididymitis. However, there are some things you can do to reduce your risk of infection. These include:

• Using condoms to prevent sexually transmitted infections
• Not having sex with multiple partners
• Performing circumcision for adult males
• Disinfecting and cleaning toilet seats after use regularly
• Receiving TB vaccinations

When to see a doctor?

If you experience worsening symptoms such as persistent pain or discomfort, no improvement in symptoms after a few days, severe pain in the scrotum, or high fever, you should see a doctor. The doctor will conduct a medical interview, physical examination, and specific supporting examinations to determine a definite diagnosis of the underlying disease and appropriate and needed management.

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