The
epididymis is a partner to the testicle in the scrotum. It has an important
role in helping sperm mature enough to be able to swim. It is almost always a
silent partner – until it’s not. Inflammation of the epididymis develops over
several days and is almost always only on one side. Symptoms are a hot, tender
and swollen hemi-scrotum. Urination may be frequent and painful.
In
young sexually active men the most common causes of epididymitis are chlamydia
and gonorrhea. In older men enteric pathogens (bad bowel bacteria) are to
blame. Treatment relies on supportive measures,
including bed rest, scrotal elevation, and analgesics, in conjunction with
empiric antibiotic therapy based on the patient's age and clinical and sexual
history. If chlamydia or gonorrhea is confirmed all sexual partners should be
treated.
There are some unusual causes of
epididymitis, such as drug induced and vasculitis. Withdrawal of the medication
and treatment of the underlying disease are appropriate. Almost all cases
resolve completely and failure to improve within three days should prompt
reevaluation of the diagnosis and/or treatment. It is important to complete a
full course of treatment to prevent complications.
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