- Clinical science
Epididymitis is an inflammation of the epididymis that is commonly associated with genitourinary tract infections. The typical presentation involves gradual onset of pain and swelling of the affected side of the scrotum as well as a positive . Epididymitis is a clinical diagnosis, but testicular torsion should be excluded by ultrasound because it has a similar presentation and is a surgical emergency. Treatment involves prompt empiric antibiotic therapy, scrotal elevation, and nonsteroidal anti‑inflammatory therapy to prevent abscess formation and possible infertility.
Epididymitis is an inflammation of the epididymis , usually as a result of an infection.
- Urinary tract infections
- Sexually transmitted infections
- Chronic epididymitis (> 6 week course of disease)
- Unilateral scrotal pain and swelling; , which develops over several days and radiates to the ipsilateral flank
- Positive : reduced pain when the affected hemiscrotum is elevated
- Scrotal skin overlying the epididymis may appear red, shiny, and edematous.
- Low-grade fever (especially among children)
- Symptoms of lower urinary tract infection (e.g., dysuria, frequency, urgency), including urethritis (urethral discharge)
- Recurrent bouts of scrotal pain
- Swelling is minimal when compared to acute epididymitis
- Thickened epididymis
- Tuberculous epididymitis
- Primarily a clinical diagnosis
- Laboratory findings
- To rule out testicular torsion if this is not possible based on history and physical exam
- If an abscess is suspected
- Findings in epididymitis: enlarged epididymis, increased blood flow
- The following tests should be performed to rule out tuberculosis:
Rule out other conditions requiring urgent intervention before diagnosing epididymitis!
- See .
The differential diagnoses listed here are not exhaustive.
- Empiric antibiotic therapy based on likely pathogens (until the causative organism is known)
- Scrotal elevation, ice packs, and NSAIDs
- If an abscess develops: surgical drainage
- Chronic epididymitis
- Epididymal abscess
- Testicular infarction
We list the most important complications. The selection is not exhaustive.