Acute epididymitis

Last reviewed: 28 Aug 2023
Last updated: 02 Dec 2022



History and exam

Key diagnostic factors

  • age >19 years
  • unilateral scrotal pain and swelling of gradual onset
  • symptoms <6 weeks' duration
  • tenderness
  • hot, erythematous, swollen hemiscrotum
  • frequent and painful micturition
  • purulent urethral discharge
More key diagnostic factors

Other diagnostic factors

  • pyrexia
  • fluctuant swelling or induration of scrotal tissue
  • enlarged or tender prostate
Other diagnostic factors

Risk factors

  • unprotected sexual intercourse
  • bladder outflow obstruction
  • instrumentation of urinary tract
  • immunosuppression
  • vasculitis
  • amiodarone
  • mumps
  • exposure to tuberculosis (TB)
More risk factors

Diagnostic investigations

1st investigations to order

  • Gram stain of urethral secretions
  • urine dipstick test
  • urine microscopy
  • urine culture
  • nucleic acid amplification test (NAAT) of urethral secretions or first-void urine for Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium
  • culture of urethral secretions
More 1st investigations to order

Investigations to consider

  • scrotal color duplex ultrasonography
  • surgical exploration
  • 3 early morning urine samples for acid-fast bacilli staining, culture, and NAAT for Mycobacterium tuberculosis
  • HIV test
  • syphilis test
More investigations to consider

Treatment algorithm


bacterial infection


underlying vasculitis

idiopathic or viral




Ameeta E. Singh, BMBS(UK), MSc, FRCPC, FIDSA

Clinical Professor

Division of Infectious Diseases

University of Alberta




AES declares that she has no competing interests.


Dr Ameeta E. Singh would like to gratefully acknowledge Dr Hossein Sadeghi-Nejad, Dr Lorenzo DiGiorgio, Dr Mary Garthwaite, and Dr Ian Eardley, previous contributors to this topic.


HSN, LDG, and MG declare that they have no competing interests. IE is a consultant to Pfizer, Lilly, and Sanofi. He is a speaker for Lilly.

Peer reviewers

Sheldon Morris, MD, MPH

Assistant Professor

Division of Infectious Diseases

Department of Medicine

UCSD Antiviral Research Center

Division of Family Medicine

Department of Family and Preventive Medicine

UCSD La Jolla Family and Sports Medicine

San Diego



SM has received research funding support from NIH CHRP, CIRM, and Gilead Sciences. He has financial interests in Impact Biomedicines (now Celgene) and Forty Seven Inc. There is no conflict between these financial interests and any content in this topic.

Altaf Mangera, MBChB (Hons), MD, FRCS (Urol), FEBU

Consultant Urologist

Department of Urology

Royal Hallamshire Hospital




AM declares that he has no competing interests.

  • Differentials

    • Testicular torsion
    • Acute idiopathic scrotal edema
    • Infected hydrocele
    More Differentials
  • Guidelines

    • ACR appropriateness criteria: acute onset of scrotal pain - without trauma, without antecedent mass
    • 2021 European guideline on Mycoplasma genitalium infections
    More Guidelines
  • Patient leaflets



    More Patient leaflets
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