Inflammation of the epididymis causing pain and swelling, which is usually unilateral and develops over the course of a few days.
In sexually active men (aged <35 years), epididymitis is most commonly caused by Chlamydia trachomatis or Neisseria gonorrhoeae .
In older men, the causative organisms are usually enteric pathogens, and epididymitis may be associated with bladder outlet obstruction, recent instrumentation of the urinary tract, or systemic illness.
Diagnostic tests include a Gram stain of urethral secretions, taken as a urethral swab, prior to obtaining a urine specimen for nucleic acid amplification tests for both C trachomatis and N gonorrhoeae .
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 C trachomatis or N gonorrhoeae are the confirmed or suspected pathogens, patients should be strongly advised to refer their sexual partner(s) for evaluation and treatment.
Acute epididymitis is inflammation of the epididymis characterized by scrotal pain and swelling of less than 6 weeks' duration. It may be associated with irritative lower urinary tract symptoms, urethral discharge, and fever. It is usually unilateral. The condition is referred to as acute epididymo-orchitis if concurrent inflammation of the testis is present. The acute presentation of epididymitis will be covered.
James Cook University Hospital
MG declares that she has no competing interests.
St James's University Hospital
IE is a consultant to Pzifer, Lilly, and Sanofi. He is a speaker for Lilly.
Consultant Urological Surgeon
Spire Manchester Hospital
SP declares that he has no competing interests.
Center for Male Fertility
Glickman Urological and Kidney Institute
ES declares that he has no competing interests.
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