Introduction
The epididymis is a collection of small coiled tubes at the back of the testicle that stores sperm. When these tubes become inflamed, generally due to a bacterial infection, the condition is called epididymitis. It can be sudden onset (acute) or longer term (chronic).
Orchitis describes inflammation of the testicle, again generally caused by a bacterial infection. Where these two conditions occur together, mainly when infection spreads from the epididymis to the testicle, this is referred to as epididymo-orchitis. The condition can affect one or both testicles.
Causes
The commonest cause of this condition is a primary infection elsewhere which spreads to the epidymis and testicle(s). Generally, this is a secondary infection caused by a urinary tract infection (UTI) and / or a sexually transmissible infection (STI) such as:
- Chlamydia trachomatis (STI).
- Neisseria gonorrhoea (STI).
- Pseudomonas (UTI).
- Klebsiella (UTI).
- Proteus spp (UTI).
- E.coli (UTI).
It can also be caused as a secondary infection as a result of:
- Tuberculosis.
- Syphilis.
- Mumps.
Risk factors
Risk factors for the condition are:
Where acquired via sexual transmission
- Prior STI.
- High risk sexual activity (including insertive anal sex).
- Multiple sexual partners.
- Sexual partner with diagnosed STI.
Where not acquired via sexual transmission
- Urinary tract infection.
- Obstruction of urine flow, often due to benign prostatic hyperplasia.
- Other genito-urinary surgery (recent).
- Use of urinary catheter.
- Some inherited conditions of the bladder and kidneys.
Symptoms
The main symptom of the condition is redness, pain / tenderness and swelling in the genital area. It is often accompanied by dysuria (painful urinating) and a fever.
Where the acute condition is not treated, it can develop into a chronic (long-term) condition and in some cases an abscess can form inside the epididymis or in severe cases the infection can permanently damage the epididymis and / or testicle which can in turn lead to infertility.
Tests / Diagnosis
When considering whether a particular range of symptoms indicates epididymo-orchitis, the medical practitioner will be considering whether other conditions may be the cause, including specifically testicular torsion, in which case immediate surgery will be required.
Tests to diagnose the cause of symptoms will generally include a physical examination and review of medical history, followed by some or all of the following:
- Urinalysis.
- Tests for presence of STIs.
- Blood tests.
- Ultrasound of the testicles and renal tract.
- Cystoscopy.