CHRONIC EPIDIDYMITIS The British Association of Urological Surgeons FREQUENTLY-ASKED QUESTIONS

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CHRONIC EPIDIDYMITIS
FREQUENTLY-ASKED QUESTIONS
What is the epididymis?
Behind each testis lies a structure called the epididymis. Sperms produced in the
testis pass through tiny channels into the epididymis where they are stored. Their
ability to swim is enhanced by chemicals produced within the epididymis.
If you hold the testis between your fingers, you may be able to feel the epididymis as
a ridge behind the testis. It is most prominent at the top and bottom of the testis (the
head & tail of the epididymis).
What is chronic epididymitis?
This is uncomfortable swelling of part of the epididymis. In some cases, a clear
infection is the cause but this is actually uncommon. In most patients, we never find
any infection and the cause is unknown. The problem is called “chronic” because it
comes and goes over a period of time.
Acute epididymitis
This is a different condition which affects the testis as well (epididymo-orchitis). It is
usually due to bacterial infection and can cause a lot of pain and swelling. It may
even result in emergency admission to hospital. It requires antibiotic treatment for at
least six weeks. Most patients need further investigation to determine the cause of
the infection. A full course of treatment is essential because incomplete treatment
can cause the infection to become chronic.
What are the symptoms of chronic epididymitis?
The commonest symptom is a low-grade ache in the testicle. It is often difficult to
localise the discomfort precisely with your fingers. The pain often radiates into the
scrotum, into the groin or into the thigh and lower back.
Sitting for prolonged periods of time may make it
worse.
If you have a genuine infection, you may notice an
alteration in the colour or consistency of your semen.
In a few patients, inflammation also affects the
prostate. This can cause discomfort in the groins, back
or thighs and may affect passage of urine.
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What tests will be done?
You GP or urologist will listen to your symptoms and examine you. Most tests are
unnecessary but, if there is any suspicion that you have an underlying testicular
lump, an ultrasound scan of the scrotum may be recommended. Culture of the
semen for bacteria is rarely performed because it does not help in diagnosis.
What can be done about it?
If there is a definite infection, you will be given an
antibiotic (Doxycycline, Co-Amoxiclav, Ofloxacin or
Trimethoprim). Most patients, however, do not
need antibiotics and respond to treatment with antiinflammatory drugs.
The nost effective is
Ibuprofen, which you can buy in chemists or
supermarkets. You should take 400mg three times
daily and continue this for a minimum of 14 days.
If you develop heartburn or indigestion whilst taking
these tablets, you should take an antacid. You should not take anti-inflammatory
drugs if you have a history of stomach ulceration or if you have asthma.
Supporting underwear often helps relieve discomfort.
You cannot transmit this condition to your sexual partner unless there is a proven
infection. Once antibiotics have removed any infection, there is no risk to your
partner.
Will this treatment cure me?
Unfortunately, not always. Some patients only ever suffer a single episode but many
patients suffer a recurrence months or even years later. If treated at an early stage
with anti-inflammatory drugs, symptom progression can be prevented. It is always
worth keeping a supply of tablets close at hand, especially if you are away from
home for any period of time. Early treatment will minimise the discomfort you
experience and may shorten the duration of the symptoms.
Are there any other important points?
This booklet contains guidelines and advice from professional bodies, together with
information about the prescription of drugs.
All NHS hospitals have local
arrangements with their Primary Care Trusts (PCTs) about which medicines can be
used. As a result, some drugs mentioned cannot be prescribed by local hospitals.
Treatment of patients will be planned with the doctor responsible for care, taking into
account those drugs which are or are not available at the local hospital and what is
appropriate for optimum patient care.
Healthcare professionals are advised to check prescribing arrangements with their
local hospital or PCT.
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Disclaimer
While we have made every effort to be sure the information in this booklet is
accurate, we cannot guarantee there are no errors or omissions. We cannot accept
responsibility for any loss resulting from something that anyone has, or has not, done
as a result of the information in this booklet.
© British Association of Urological Surgeons (BAUS) Limited
Published: March 2014
Due for review: March 2015
CHRONIC EPIDIDYMITIS
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