Diagnosis

Your doctor will check for enlarged lymph nodes in your groin and an enlarged testicle on the affected side. Your doctor might also do a rectal examination to check for prostate enlargement or tenderness.

Tests your doctor might recommend include:

  • STI screening. A narrow swab is inserted into the end of your penis to obtain a sample of discharge from your urethra. The sample is checked in the laboratory for gonorrhea and chlamydia.
  • Urine and blood tests. Samples of your urine and blood are analyzed for abnormalities.
  • Ultrasound. This imaging test might be used to rule out testicular torsion. Ultrasound with color Doppler can determine if the blood flow to your testicles is lower than normal — indicating torsion — or higher than normal, which helps confirm the diagnosis of epididymitis.

Treatment

Antibiotics are needed to treat bacterial epididymitis and epididymo-orchitis. If the cause of the bacterial infection is an STI, your sexual partner also needs treatment. Take the entire course of antibiotics prescribed by your doctor, even if your symptoms clear up sooner, to ensure that the infection is gone.

You should start to feel better within 48 to 72 hours of starting an antibiotic. Resting, supporting the scrotum with an athletic strap, applying ice packs and taking pain medication can help relieve discomfort.

Your doctor is likely to recommend a follow-up visit to check that the infection has cleared.

Surgery

If an abscess has formed, you might need surgery to drain it. Sometimes, all or part of the epididymis needs to be removed surgically (epididymectomy). Surgery might also be considered if epididymitis is due to underlying physical abnormalities.

Lifestyle and home remedies

Epididymitis usually causes considerable pain. To ease your discomfort:

  • Rest in bed
  • Lie down so that your scrotum is elevated
  • Apply cold packs to your scrotum as tolerated
  • Wear an athletic supporter
  • Avoid lifting heavy objects
  • Avoid sexual intercourse until your infection has cleared

Preparing for your appointment

You might be referred to a doctor who specializes in urinary issues (urologist).

What you can do

Make a list of:

  • Your symptoms and when they began
  • Key medical information, including previous STIs
  • All medications, vitamins or supplements you take, including doses
  • Questions to ask your doctor

Some questions to ask your doctor include:

  • What's the most likely cause of my symptoms? Are there other possible causes?
  • What tests do I need?
  • What treatments are available?
  • How long will it take for me to feel better?
  • Should my partner be tested for an STI?
  • Should I restrict sexual activity?
  • I have other medical problems. How can I best treat them together?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, including:

  • How severe are your symptoms? Are they constant or occasional?
  • What, if anything, seems to improve or worsen your symptoms?
  • Do you have discharge from your penis or blood in your semen?
  • Do you have pain when you urinate or a frequent or urgent need to urinate?
  • Do you have pain during intercourse or when you ejaculate?
  • Have you or your partner had or been tested for an STI?
  • Do you do heavy lifting?
  • Have you been diagnosed with a prostate condition or urinary tract infection?
  • Have you had surgery in or near your urinary tract, or surgery that required the insertion of a catheter?
  • Have you had a groin injury?

What you can do in the meantime

While you wait for your appointment, avoid sexual contact that could put your partner at risk of contracting an STI, including sexual intercourse, oral sex and any skin-to-skin contact with your genitals. Let your sex partner or partners know about your signs and symptoms so that they can also seek testing.

Oct. 20, 2017
References
  1. Epididymitis. Centers for Disease Control and Infection. https://www.cdc.gov/std/tg2015/epididymitis.htm. Accessed Aug. 21, 2017.
  2. Epididymitis. Merck Manual Professional Version. https://www.merckmanuals.com/professional/genitourinary-disorders/penile-and-scrotal-disorders/epididymitis. Accessed Aug. 21, 2017.
  3. Eyre RC. Evaluation of acute scrotal pain in adults. https://www.uptodate.com/contents/search. Accessed Aug. 21, 2017.
  4. Eyre RC. Evaluation of nonacute scrotal conditions in adults. https://www.uptodate.com/contents/search. Accessed Aug. 21, 2017.
  5. Rupp T, et al. Epididymitis. In: StatPearls (Internet). Treasure Island, Fla.: StatPearls Publishing; 2017. https://www.ncbi.nlm.nih.gov/books/NBK430814/. Accessed Aug. 21, 2017.