Epididymitis

Epididymitis refers to the inflammation of the epididymis, which is a coiled tube in the back of the testicle that transports and stores sperm. It carries sperm from the testes to the vas deferens, which then transports sperm to the ejaculatory ducts. 

The most common causes of epididymitis are bacterial infections. Most often, the infection begins in the urethra, bladder, or prostate, and can reach the epididymis through retrograde spread. Other, less frequent, spreading routes include the bloodstream or the lymphatic system.

In children, the infectious pathogen is typically Escherichia coli (E. coli), a species of opportunistic bacteria which normally colonizes the intestines, but can also cause urinary tract infections. 

For adults under 35 years of age, the most common causes include paramyxoviruses like the mumps virus and sexually transmitted disease (STDs) like gonorrhea and chlamydia, respectively caused by the bacteria Neisseria gonorrhoeae and Chlamydia trachomatis. This is why sexually active adults are at an increased risk for epididymitis, especially those practicing anal intercouse. Individuals with obstruction or congenital abnormalities of the urinary tract are also at increased risk. Other non-infectious causes of epididymitis include trauma, vasculitis (inflammation of blood vessels), medications (such as amiodarone), and autoimmune diseases. Finally, a portion of cases are idiopathic, meaning there is an unknown cause. 

Differential diagnoses involve considering various possible conditions that could be causing symptoms and then ruling out each one through use of history, clinical evaluation, diagnostic tests, and critical thinking. This process helps to narrow down the list of potential diagnoses to determine the most likely cause of the symptoms. 

Differential diagnoses can be broken down into four categories: most likely, less likely, least likely, and can’t miss. Most likely diagnoses are conditions most probable based on symptoms and clinical presentation. Less likely diagnoses are not as probable but should still be considered. On the other hand, least likely diagnoses can be considered if other, more probable conditions are excluded. Finally, can’t miss diagnoses are less common but critical to promptly identify and treat as they can lead to severe consequences.  

Differential diagnoses for epididymitis include:  

Pain and discomfort associated with epididymitis are managed by rest, elevation of the scrotum, cold packs, and non-steroidal anti-inflammatory drugs (NSAIDs). Additionally, infectious cases of epididymitis can be treated with antibiotics. If epididymitis is caused by sexually transmitted disease, the physician may recommend that the individual’s sex partner also undergo antibiotic treatment. On the other hand, non-infectious cases of epididymitis need treatment for their underlying cause, or the withdrawal of any causative medication.

Though most people can be treated from home, hospitalization may be considered for severe cases, systemic infections, or individuals with additional diseases (such as diabetes or immunosuppression). Surgery for treatment of epididymitis is not recommended, due to its high failure rate and potential risk of infertility.