What is Epididymitis?
Epididymitis is a medical condition characterized by discomfort or pain in of the epididymis, a curved structure at the back of the testicle in which sperm matures and is stored. Epididymitis is usually characterized as either acute or chronic: if acute, the onset of testicular pain is often accompanied by inflammation, redness, and warmth in the scrotum; if chronic, pain may be the only symptom. In either form, testicular pain in one or both testes can vary from mild to severe, and one or both epididymides may noticeably swell (inflame) and/ or harden (indurate). The pain is often cyclical and may last from less than an hour to several days. Epididymitis is the most frequent cause of acute onset scrotal pain in adults. In contrast with men that have testicular torsion, the cremasteric reflex (elevation of the testicle in response to stroking the upper inner thigh) is not altered. If the diagnosis is not entirely clear from the patient’s history and physical examination, a Doppler ultrasound scan can confirm increased flow of blood to the affected epididymis (whereas torsion is characterized by ischemia). If the inflammation spreads to the testicle, the condition may be reclassified as epididymo-orchitis or orchiepididymitis. The swelling from epididymitis may stretch along the inguinal canal and may appear similar to that of a hernia, particularly an inguinal hernia. It may be distinguished from these, however, in that with the exception of an incarcerated indirect inguinal hernia, inguinal hernias generally are not painful, and the swelling they produce often disappears upon lying down. Neither is the case with epididymitis.
Causes of Epididymitis
Though urinary tract infections in men are rare, bacterial infection is the most common cause of acute epididymitis.The bacteria in the urethra back-track through the urinary and reproductive structures to the epididymis. There can be associated urethritis (inflammation of the urethra). In rare circumstances, the infection reaches the epididymis via the bloodstream. In sexually active men, Chlamydia trachomatis is responsible for two-thirds of acute cases, followed by Neisseria gonorrhoeae and ecoli (or other bacteria that cause urinary tract infection). Particularly among men over age 35 in whom the cause is E. coli, epididymitis is commonly due to urinary tract obstruction. Less common microbes include Ureaplasma, Mycobacterium, and cytomegalovirus, or Cryptococcus in patients with HIV infection. E. coli is more common in boys before puberty, the elderly, and men who have sex with men. In the majority of cases in which bacteria are the cause, only one side of the scrotum or the other is the locus of pain Non-infectious causes are also possible. Reflux of sterile urine (urine without bacteria) through the ejaculatory ducts may cause inflammation with obstruction. In children, it may be a response following an infection with enterovirus, adenovirus or Mycoplasma pneumoniae. Rare non-infectious causes of chronic epididymitis include sarcoidosis (more prevalent in black men) and Behçet’s disease.Any form of epididymitis can be caused by genito-urinary surgery, including prostatectomy and urinary catheterization. Congestive epididymitis is a long-term complication of vasectomy. Chemical epididymitis may also result from drugs such as amiodarone.
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