Overview: What is epididymitis and testicular inflammation?
In epididymitis, pathogens such as viruses, bacteria and, in rare cases, fungi infect the epididymis. Together with the penis and testicles, the epididymis belongs to the male sex organs. The epididymis and testicles are located in the scrotum. The function of the testicles is to produce sex hormones as well as sperm. From there, the sperm are transported to the epididymis, where they are stored. Sperm are transferred from the epididymis to the urethra via the ductus deferens during ejaculation.
The testicles can also become inflamed. However, orchitis is much rarer than epididymitis. The testicles can also be affected, particularly in the case of severe epididymitis. The infection therefore spreads between the two organs, which are in close proximity. This simultaneous inflammation of the epididymis and testicles is known medically as epididymorchitis.
Causes and risk factors of epididymitis and testicular inflammation
In addition to infectious causes, severe violence, trauma from outside, such as kicks, blows and pinching of the testicles, can also trigger epididymitis and/or testicular inflammation. Testicular torsion, i.e. twisting of the testicle, can also lead to epididymitis/orchitis. However, bacteria and viruses are by far the most common cause. These ascend via the urethra and the seminal ducts into the epididymis, in such cases this is medically referred to as an ascending infection.
Possible origin of the pathogens: from a
- Cystitis
- Urethritis
- Prostatitis
- Bladder stones
- Sexually transmitted germs (chlamydia, gonococcus (gonorrhea), syphilis)
The main causes of epididymitis and testicular inflammation are intestinal bacteria such as Escherichia coli, Klebsiella and enterococci. Staphylococci also play a role, rarely also fungi/yeasts. Testicular inflammation can also be caused by viruses, such as the mumps virus or the Epstein-Barr virus, which is the cause of mononucleosis. In these cases, the pathogens have entered the testicles via the bloodstream. A severe case of mumps can cause a reduction in fertility or even lead to infertility.
Other risk factors for epididymitis, testicular inflammation are:
- a permanently inserted urinary catheter because it can introduce bacteria and fungi into the urogenital tract.
- Obstructions to the outflow of urine from the bladder or kidneys that lead to urinary retention – for example due to an enlarged prostate. Urine that remains in the bladder for too long (residual urine) provides ideal conditions for bacteria and fungi to grow. Regular and complete emptying of the bladder is very essential in order to prevent the bladder from becoming a reservoir for pathogens.
- Rheumatic diseases
- unprotected sexual intercourse – condoms protect against chlamydia and other sexually transmitted pathogens.
Symptoms: Very similar in epididymitis and testicular inflammation
The signs of inflammation can start suddenly (acute inflammation) or develop slowly at first and then increase sharply within a few days.
The most important leading symptoms of epididymitis and/or testicular inflammation (= epididymorchitis) are:
- Pain in the scrotum, severe sensitivity to pressure
- The skin of the scrotum feels overheated and is reddened.
- The skin of the scrotum is partially darkened.
- The scrotum is swollen, the folds of the scrotal skin are partially gone, the skin is taut.
- The pain can radiate into the groin and abdomen.
- Alarm signs are: High fever, chills, sometimes nausea and vomiting!
If the scrotum is swollen and painful, experts also refer to this as “acute scrotum”, which is typical of inflammation of the testicles and/or epididymis.
Each of these signs should be clarified by a doctor as soon as possible. However, if you experience chills, high fever, nausea and vomiting or if your symptoms suddenly increase, you should not hesitate to consult us immediately. This could already be the first signs of blood poisoning (= sepsis).
Epididymitis and testicular inflammation: Diagnosis with us
First we will ask you about your complaints and previous illnesses (= anamnesis). We want to know the following:
When the symptoms first appeared, whether they came on suddenly or started slowly, whether there are additional problems with urination or whether you have noticed discharge from the penis. We will also ask you about sexual intercourse, as it could also be a sexually transmitted disease.
After this anamnesis, we will examine you physically. This usually involves a detailed inspection of the scrotum, including careful palpation of the scrotum and groin area. In addition, by lifting the testicle we can determine whether there is a suspicion of epididymitis or another disease of the testicle:
- If the symptoms are reduced by lifting the scrotum, it could be epididymitis.
- If the pain does not change, this is more likely to indicate testicular inflammation or testicular torsion.
In addition, a urine test provides information on whether and, if so, which pathogens are causing the infection. A blood test is carried out in addition, especially in the case of fever or chills, and shows how severe the inflammation is.
Imaging procedures such as an ultrasound examination of the testicles then show even more precisely which disease is present. We can see exactly whether the inflammation is limited to the epididymis or whether the testicles are also affected. It is also possible to detect or rule out whether pus has already accumulated and an abscess (= accumulation of pus) is developing.
Epididymitis and testicular inflammation: prevention, early detection, prognosis
Measures to prevent epididymitis and testicular inflammation are not known. Only testicular inflammation caused by mumps (mumps orchitis) can be safely prevented by vaccination against mumps. Vaccination provides reliable protection against this infectious disease and thus also against its complications, such as testicular inflammation. In general, men should protect themselves from violence in the genital area and wear appropriate protection when playing sports such as ice hockey, football or boxing.
Do not hesitate to consult us at the first signs, i.e. pain in the scrotum, a feeling of heat and redness of the skin in this area. If detected quickly, targeted treatment can begin at an early stage and thus bring the best possible healing success – and prevent permanent damage caused by the inflammation.
Course and prognosis of epididymitis and testicular inflammation
The prognosis for these infections is good, and they usually heal completely and without sequelae if treated correctly. It takes around ten days for the signs of acute inflammation to subside. After that, it may take a few weeks until the scrotum is inconspicuous again, no longer painful and no longer swollen.
But caution is advised: Overall, both diseases – epididymitis and testicular inflammation – can temporarily reduce sperm production, although this later returns to normal in most cases.
However, if the therapy is not fully effective or has not been treated for long enough, epididymitis can become chronic. These protracted epididymitis can lead to scarring of the seminal ducts and ultimately to their closure. This increases the risk of infertility.
Inadequately treated testicular inflammation also carries the risk that testosterone is no longer produced in line with age. The testosterone level can therefore drop. Infertility and hormone deficiency can therefore be the permanent damage caused by protracted epididymitis and testicular inflammation.
A particularly dangerous complication of epididymitis and testicular inflammation is the local accumulation of pus, known as abscess formation. It can not only necessitate the removal of the epididymis and testicles, but can also trigger life-threatening blood poisoning = sepsis. You should therefore always have inflammation of the testicles and epididymis checked by a doctor as soon as possible in order to avoid irreversible consequential damage.
Unfortunately, this is not always possible with mumps orchitis, despite treatment. Men affected by the disease are unable to conceive because the testicular tissue and thus the sperm are directly damaged by the inflammation or the testicles subsequently produce too few sperm.