UROLOGY · CONDITIONS
Epididymitis
Inflammation of the epididymis causing acute scrotal pain and swelling , requires prompt antibiotic therapy and evaluation to prevent complications and preserve fertility.
ABOUT THIS CONDITION
What is Epididymitis?
Epididymitis is inflammation of the coiled tubular structure at the back of the testis, commonly caused by sexually transmitted infections (Chlamydia, gonorrhoea) in young men or enteric bacteria in older men with BPH or following urological procedures. It causes acute scrotal pain, swelling, fever, and tenderness. Dr. Vipin provides urgent assessment , including Doppler ultrasound to exclude testicular torsion , followed by targeted antibiotic therapy, STI screening, and partner notification where appropriate to prevent complications and fertility sequelae.
SIGNS TO WATCH
Common Symptoms
Symptoms that need attention
WHY IT HAPPENS
Causes & Risk Factors
- Chlamydia trachomatis , most common in men under 35
- Neisseria gonorrhoeae (gonorrhoea)
- Enteric bacteria (E. coli) , common in men over 35
- Post-urological surgery or catheterisation
- BPH causing urinary stasis and ascending infection
- Tuberculosis , rare cause of chronic epididymitis
CLINICAL DETAILS
KeyFacts
Doppler scrotal ultrasound urgently excludes torsion and confirms epididymal inflammation.
Urethral swab and first-void urine PCR for Chlamydia and gonorrhoea in all sexually active men.
Doxycycline ceftriaxone IM for STI. Fluoroquinolone for enteric bacteria. Full course essential.
Sexual partner notification and treatment mandatory for STI-related epididymitis.
Symptoms improve within 2–3 days. Complete resolution of swelling takes 2–4 weeks.
Untreated epididymitis can progress to abscess, testicular involvement, or epididymal obstruction.
HOW WE TREAT IT
Treatment Approach
Culture-Guided Antibiotic Therapy
Targeted antibiotic treatment based on urine culture and STI PCR results , the cornerstone of epididymitis management, combined with scrotal support and analgesia for rapid symptom resolution.
- 1
Exclude Torsion First
Doppler ultrasound is performed urgently to confirm blood flow to the testis and exclude testicular torsion , which requires emergency surgery.
- 2
Swabs & Culture
Urethral swab, first-void urine PCR, and midstream urine culture identify the causative organism and guide antibiotic selection.
- 3
Antibiotic Therapy
Empirical dual antibiotic therapy is started immediately , narrowed to culture-specific agents within 48–72 hours once sensitivities are available.
- 4
Follow-up & Prevention
Repeat clinical assessment at 2 weeks confirms resolution. STI partner notification completed. Semen analysis offered if fertility is a concern.
AVAILABLE TREATMENTS
Treatment Options
Scrotal Exploration Abscess Drainage
Surgical exploration and drainage of an epididymal or testicular abscess that fails to resolve with antibiotics alone , performed under general anaesthesia.
Epididymectomy
Removal of the epididymis through a scrotal incision for chronic epididymo-orchitis causing intractable pain, recurrent abscess, or obstructive azoospermia.
COMMON QUESTIONS
Frequently Asked
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