Epididymitis Treatment & Management

  • Author: Christina B Ching, MD; Chief Editor: Edward David Kim, MD, FACS   more...
 
Updated: Jun 10, 2011
 

Approach Considerations

In chronic epididymitis, a 4- to 6-week trial of antibiotics for bacterial pathogens, especially against chlamydial infections, is appropriate.

When treating epididymitis secondary to C trachomatis or N gonorrhoeae, treatment of all sexual partners is necessary in order to limit the rate of recurrence and to achieve maximal cure rates. Reinforce the advisability of condom use in the prevention of sexually transmitted disease.

Given the low incidence of urinary tract infections in boys with epididymitis, in prepubertal patients, antibiotic therapy can be reserved for young infants and those with pyuria or positive urine culture findings. Because predicting a positive urine culture result is difficult, urine cultures should be obtained on all pediatric patients with epididymitis.[3]

Obtain immediate consultation with a urologist upon suspicion of testicular torsion, scrotal abscess, or failed medical treatment.

Orchiectomy is indicated only for patients with unrelenting epididymal pain, although up to 50% of patients still report phantom postoperative pain. Conduct an epididymotomy infrequently in patients with acute suppurative epididymitis. In rare cases, refractory pain due to chronic epididymitis and orchalgia has been managed with skeletonization of the spermatic cord via subinguinal varicocelectomy. Viral mumps has no surgical indications.

Go to Emergent Management of Acute Epididymitis for complete information on this topic.

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Supportive Therapy

In addition to antibiotics (except in viral epididymitis), the mainstays of supportive therapy for acute epididymitis and orchitis are as follows:

  • Reduction in physical activity
  • Scrotal support and elevation
  • Ice packs
  • Anti-inflammatory agents
  • Analgesics, including nerve blocks
  • Avoidance of urethral instrumentation
  • Sitz baths
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Epididymectomy and Epididymotomy

Epididymectomy

Epididymectomy was once reported to offer a limited chance (at best 50%) of relieving pain caused by chronic epididymitis.

However, a study by Siu et al found that 70% of patients who underwent epididymectomy in the face of chronic epididymal pain (in the setting of postvasectomy pain, obstruction due to radical retropubic prostatectomy or hernia repair, epididymal cysts, or chronic epididymitis) reported pain resolution.[4] In this same study, 91% of patients reported satisfaction with their decision for surgery. Despite these findings, it is still suggested that surgery be reserved only for refractory cases.

The possibility of fertility sequelae should also be discussed with the patient.

Pain relief is often transient and is followed by pain recurrence or transfer of symptoms to the contralateral testicle.

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Contributor Information and Disclosures
Author

Christina B Ching, MD  Resident Physician, Department of Urology, Cleveland Clinic Foundation

Christina B Ching, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Student Association/Foundation, and American Urological Association

Disclosure: Nothing to disclose.

Coauthor(s)

Edmund S Sabanegh Jr, MD  Chairman, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation

Edmund S Sabanegh Jr, MD is a member of the following medical societies: American Medical Association, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Society for the Study of Male Reproduction, Society of Reproductive Surgeons, and Southwest Oncology Group

Disclosure: Nothing to disclose.

Specialty Editor Board

Erik T Goluboff, MD  Professor, Department of Urology, College of Physicians and Surgeons, Columbia University College of Physicians and Surgeons; Director of Urology, Allen Pavilion, New York Presbyterian Hospital

Erik T Goluboff, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Urological Association, Medical Society of the State of New York, New York Academy of Medicine, Phi Beta Kappa, and Society for Basic Urologic Research

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS  Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association

Disclosure: Lilly Consulting fee Advisor; Astellas Consulting fee Speaking and teaching; Watson Consulting fee Speaking and teaching; Allergan Consulting fee Speaking and teaching

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Michael Franks, MD, and Badrinath R Konety, MD, to the development and writing of the source article.

References

  1. Siegel A, Snyder H, Duckett JW. Epididymitis in infants and boys: underlying urogenital anomalies and efficacy of imaging modalities. J Urol. Oct 1987;138(4 Pt 2):1100-3. [Medline].

  2. Santillanes G, Gausche-Hill M, Lewis RJ. Are antibiotics necessary for pediatric epididymitis?. Pediatr Emerg Care. Mar 2011;27(3):174-8. [Medline].

  3. Siu W, Ohl DA, Schuster TG. Long-term follow-up after epididymectomy for chronic epididymal pain. Urology. Aug 2007;70(2):333-5; discussion 335-6. [Medline].

  4. Viswaroop BS, Kekre N, Gopalakrishnan G. Isolated tuberculous epididymitis: a review of forty cases. J Postgrad Med. Apr-Jun 2005;51(2):109-11, discussion 111. [Medline].

  5. Trei JS, Canas LC, Gould PL. Reproductive tract complications associated with Chlamydia trachomatis infection in US Air Force males within 4 years of testing. Sex Transm Dis. Sep 2008;35(9):827-33. [Medline].

  6. Nusbaum MR, Wallace RR, Slatt LM, Kondrad EC. Sexually transmitted infections and increased risk of co-infection with human immunodeficiency virus. J Am Osteopath Assoc. Dec 2004;104(12):527-35. [Medline].

  7. Waldert M, Klatte T, Schmidbauer J, Remzi M, Lackner J, Marberger M. Color Doppler sonography reliably identifies testicular torsion in boys. Urology. May 2010;75(5):1170-4. [Medline].

 
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Cross-section illustration of a testicle and epididymis. A: Caput or head of the epididymis. B: Corpus or body of the epididymis. C: Cauda or tail of the epididymis. D: Vas deferens. E: Testicle. Illustration by David Schumick, BS, CMI. Reprinted with the permission of the Cleveland Clinic Center for Medical Art and Photography © 2009. All Rights Reserved.
Color Doppler sonogram of the left epididymis in a patient with acute epididymitis. The image demonstrates increased blood flow in the epididymis resulting from the active inflammation.
Scrotal sonogram demonstrating the presence of a hydrocele and an enlarged epididymis in a patient with epididymitis. The echogenic white area is the normal testicle surrounded by the hydrocele.
Scrotal sonogram showing the testes adjacent to the inflamed epididymis with a reactive hydrocele.
 
 
 
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