Epididymitis: symptoms, treatment and prevention

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Epididymitis or Epidiymo-orchitis is a condition that affects people with penises. Symptoms include pain and swelling inside the scrotum (balls).

What causes Epididymitis?

Epididymitis is due to an infection either in the:

  • Epididymis – the tube carrying the sperm from the testicle to the urethra (the tube through which you pass urine)
  • Testicle
  • Epididymis and testicle

An infection of the epididymis is called epididymitis. An infection of the testicle is called orchitis. Infection of both the epididymis and the testicle is called epididymo-orchitis.

An immediate examination is needed to make sure you don’t have a twisted testicle (testicular torsion) as this can result in long-term damage to the testicle if not dealt with quickly. Epididymitis and epidiymo-orchitis are easily treated with antibiotics, painkillers and rest, but the pain can take weeks to months to completely go away.

How do you get epididymitis?

In most cases under the age of 35, epididymitis or epididymo-orchitis is caused by a sexually transmitted infection (STI) such as chlamydia or gonorrhoea. In most cases over the age of 35, epididymitis or epididymo-orchitis is caused by the same bacteria that cause urinary tract infections.

This may also occur after surgical procedures such as cystoscopy or catheterisation. Occasionally it may be caused by a ‘gut’ bacterial infection from penetrative anal sex. Rarely, it may be caused by other infections such as mumps or tuberculosis.

What symptoms would I have with epididymitis?

  • Pain and swelling in one or sometimes both of your testicles that comes on suddenly
  • Discharge from the tip of the penis 
  • Pain on passing urine.
  • Feeling generally unwell with a fever

How can I be tested for epididymitis?

Epididymitis or epididymo-orchitis is diagnosed based on your symptoms and what the doctor or nurse finds when they examine you.

An examination may include:

  • A groin examination
  • A swab of the tube that carries pee out of the body (urethra) – to test for infection
  • Urine and blood tests
  • A rectal examination – to check for problems with your prostate

You will need to visit your GP or a sexual health clinic for a diagnosis. If there is any concern that you may have a twisted testicle (testicular torsion), you will be referred for further tests and examination.

If you have epididymitis or epididymo-orchitis, you will likely be asked to give a urine sample and recommended to have a sexual health screen (this tests for routine sexually transmitted infections including chlamydia, gonorrhoea, syphilis and HIV). This will help to find out what may have caused your infection.

How is epididymitis treated?

Epididymitis or epididymo-orchitis is treated with antibiotics to cover the most likely infections. This may include an injection as well as tablet treatment. You will be advised to rest, wear a scrotal (ball bag) support and take regular painkillers (for example ibuprofen or paracetamol).

If your symptoms get worse or do not improve within 3 days, you should go back to your doctor or nurse, or seek further medical advice. Testicular pain and swelling often takes many weeks or months to fully settle after treatment.

What about my partner?

If you have been diagnosed with an STI, it is important that all of the people you have recently been in sexual contact with are given the option to be tested and treated. Your doctor or sexual health nurse will discuss this with you.

When can I have sex again?

You will have to wait until you have finished the antibiotics and have had a check-up by your doctor before having sex again, even sex with a condom or oral sex. If you were diagnosed with an STI, it is important that you don’t have sex with your partner before they are tested and treated as you could become infected again.

What happens if epididymitis is left untreated?

If you do not get treatment, the testicular pain and swelling will last much longer. An untreated infection is more likely to lead to complications such as long-term testicular pain or an abscess. In rare cases, untreated infection can lead to shrinkage of the testicle and loss of fertility.

How can I protect myself against Epididymitis?

There are many great options to help protect your sexual health, but none of them are 100% effective. Even if you use condoms every time you have penetrative sex, you are still at risk of getting genital warts and herpes, as these can be passed through skin-to-skin contact. Going for an STI check or taking a home STI testing kit with a partner before having sex, can be a great way of protecting yourself and those you have sex with against STIs and HIV. However, not all STI checks check for all STIs, so it is important to speak to your healthcare provider and ask them what is being tested for as part of your screening.

Discussing with your sexual partners the type of contraception or protection options available to you, and agreeing on a type that works for everyone involved can help to reduce the risk of pregnancy, STIs and HIV. Looking out for sores or symptoms on a partner’s genitals before having sex with them, can help to identify STIs that they may not be aware of. If you do see any signs that someone may have an STI, do not have sex with them until you know for certain it is safe to do so. Asking someone about their sexual health history is the responsible thing to do before having sex, and it should not be taken as an insult if someone asks you about yours. 

Looking after your mental health after an STI diagnosis

If you are diagnosed with an STI, you might feel a mixture of emotions. Unfortunately, there is still stigma in our society surrounding STIs that can cause some people to feel shame about having one. However, like any other healthcare diagnosis, you are not to blame for your STI and have not done anything “wrong”. Being diagnosed with an STI can have a negative impact on your mental health and wellbeing and if you don’t feel comfortable telling friends or family about it, you might feel isolated and alone. If you have found out you have an STI and you’re finding it difficult to cope, there are things you can do to support your mental health. 

  • Remember that STIs are common and lots of people have one at some point in their life, even though they aren’t talked about a lot 
  • Take time out to do something you enjoy and practice self-care
  • Reach out for mental health support if you need it. If you don’t feel comfortable talking to a friend or family member, our 24/7 anonymous text service, 50808, can help
  • Be patient with yourself and allow yourself to feel your emotions. It’s ok to be upset when you find out you need healthcare treatment. It’s important to take the time you need to adjust
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