Incidence is less than 1 in 1000 males per year.

An inflammation or infection of the epididymis, a convoluted duct that lies in the posterior surface of the testicle.

The most common cause of intrascrotal inflammation.

Most often due to retrograde extension of organisms from the vas deferens.

Typically present with unilateral scrotal pain, warm and swelling.

The cremasteric reflex in epididymitis is usually present. 

Acute epididymitis usually lasts less than 6 weeks duration.

Occurs with increased frequency in younger men under the age of 40 years and in men who engage in unprotected anal intercourse.

Most cases caused by C trachomatis and N gonorrhea.

May be caused by infectious and noninfectious reasons.

For men under 35 years the most frequent cause is infectious epididymitis by C trachomatis or N gonorrhea.

In elderly men coliforms, with Escherichia coli, being the most common organism found.

In the elderly felt to be due to related urinary tract obstructive disease.

Higher incidence in HIV positive patients.

Uncommon organism can be the cause in immunosuppressed patients with Candida, Cytomegalovirus, Brucella species and Mycobacterium tuberculosis.

Noninfectious causes include amiodarone, sarcoidosis, vascultic processes.

Generally diagnosed in a patient with a swollen, tender epididymitis.

The pain of epididymitis is typically localized to the epididymis at the rear pole of the testicle. 

Epididymitis may be characterized by discoloration and swelling of the testis, and fever. 

The testicle and spermatic cord may be enlarged and tender as the infection spreads.

Most important differential diagnosis is a testicular torsion.

The primary means for testing is examination of the urine.

First void urine testing for leukocyte esterase and or microscopic findings of 10 or more white blood cells per high power field.

In men with urethritis, a Gram stain of urethral discharge should be done to evaluate for the presence of white blood cells and to possibly identify intracellular gram-negative diplococci indicative of gonococcal infection.

Testing of urine for nucleic acid amplification for C trachomatis and N gonorrhoeae should be done.

Ultrasound is commonly done in this situation, but has no diagnostic advantage in patients with a history and physical examination suggesting the diagnosis.

A marked decrease in pain in association with lifting the scrotum, Prehn’s sign, helps to make the diagnosis

Treatment includes scrotal elevation, bed rest, NSAIDs, antibiotics with to treat for gonococcal and/or Chlamydia infections: parenteral ceftriaxone as a single dose and doxycycline for 10 days.

Fluoroquinolones no longer recommended because of the widespread resistance to N. gonorrhoeae.

Sexual partners with the patient within preceding 60 days should be referred for evaluation and treatment.

Patients and their partners should avoid sexual contact until treatment is completed and they are asymptomatic.

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