Acute epididymitis

Acute epididymitis is inflammation of the epididymis causing pain and swelling that develops over the course of a few days and lasts <6 weeks. It is usually unilateral.

In sexually active men, epididymitis is most commonly caused by sexually transmitted organisms including Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium.

In older men, the causative organisms are often enteric pathogens, and epididymitis may be associated with bladder outlet obstruction, recent instrumentation of the urinary tract, or systemic illness.

Diagnostic tests include a Gram stain of urethral secretions, and urine specimens for nucleic acid amplification tests for C trachomatis, N gonorrhoeae, and M genitalium (where available). Urine microscopy and culture is also indicated if urinary pathogens are suspected.

Treatment relies on supportive measures, including bed rest, scrotal elevation, and analgesics, in conjunction with empirical antibiotic therapy based on the patient's age, and clinical and sexual history. Once diagnostic test results are available, antibiotics can be adjusted to target the causative organism(s).

If C trachomatis, N gonorrhoeae, or M genitalium are the confirmed or suspected pathogens, evaluation and treatment of the patients’ sexual partner(s) is essential to prevent re-infection and ongoing transmission.

Acute epididymitis is inflammation of the epididymis characterised by scrotal pain and swelling of less than 6 weeks' duration.[1]Taylor SN. Epididymitis. Clin Infect Dis. 2015 Dec 15;61 Suppl 8:S770-3. https://www.doi.org/10.1093/cid/civ812 http://www.ncbi.nlm.nih.gov/pubmed/26602616?tool=bestpractice.com It may be associated with irritative lower urinary tract symptoms, urethral discharge, and fever. It is usually unilateral. The condition is referred to as acute epididymo-orchitis if concurrent inflammation of the testis is present. The acute presentation of epididymitis will be covered.