The difference between epididymitis and orchitis
At the time of installation of the inflammation, pain and swelling may appear in the area of the testicles. Occasionally, epididymitis can be accompanied by inflammation of the testicle – epididymal-orchitis. Epididymitis can affect men of all ages, but it mainly occurs in those between 14 and 35 years old. The treatment is relatively simple, but if the disease is left untreated, it can cause complications.
Causes of scrotal pain
The causes of scrotal pain differ depending on the age of the affected person, the medical history, as well as the level of sexual activity. Most often, scrotal pain is a symptom of epididymitis, orchiepididymitis, or testicular torsion. Scrotal pain can also occur after a trauma, a strangulated inguinal hernia or a vasectomy. Thus, for epididymitis and orchiepididymitis, several types of determining causes can be distinguished, the most frequent being of an infectious nature.
Sexually active men
Most of the time, scrotal pain occurs against the background of a sexually transmitted infection (STI). In general, it is chlamydia or gonorrhea or even both. The initial area of infection is the urethra. This is a tubular vessel through which urine and seminal fluid pass from the penis. At some point, the bacteria spread and the entire reproductive tract ends up attacking the epididymis.
The inflammation can appear several months after the sexual contact that caused the spread of the STI. Sometimes the first symptoms are specific to urethral infection; these include the burning sensation when urinating, frequent urination, pain in the lower abdomen, and the urge to urinate. Sometimes, epididymitis-specific symptoms are the first and only symptoms of STI infection. These include swelling and heating of the scrotum, testicular pain on one side, which intensifies over time, discharge from the penis, and blood in the semen.
In the case of men who practice anal sex, epididymitis is usually caused by bacteria from the anal area; they reach the urethra area through the penis, and from there, to the epididymis.
Adults at high medical risk
Men who have frequent urinary or prostate infections have a higher risk of epididymitis. For them, the infection is caused by bacteria that enter the urinary canal and reach the epididymis. Also, epididymitis can appear after performing an operation or diagnosing a disease in the area of the urethra or bladder. Sometimes, scrotal pain can also occur as a result of inserting a catheter to collect urine. The main cause, however, is still bacterial.
Furthermore, men with HIV/AIDS or other conditions that weaken the immune system are more likely to develop epididymitis. They have forms of epididymitis caused by viruses (cytomegalovirus) or mycotics (actinomycosis).
In rare cases, epididymitis occurs when there is a major infection throughout the body. This spreads through the bloodstream and reaches the epididymis.
A non-infectious form of the disease occurs in men who take amiodarone. This is a heart medicine, which can accumulate in the epididymis, causing inflammation.
Other situations
Epididymitis can also have non-bacterial causes. Although it is a rare cause, epididymitis can occur due to the penetration of urine into the epididymis – for example during the Valsalva maneuver, or when lifting weights, it can also occur as a result of a groin trauma.
Risk factors
Scrotal pain is more likely to occur in the following cases:
- Sex with a partner who has a sexually transmitted disease
- Sex without a condom
- history of sexually transmitted infections
- History of urinary tract or prostate infections
- An uncircumcised penis or an abnormality of the urinary tract
- Prostate enlargement – may increase the risk of urinary infections or epididymitis
- Cycling or riding a motorcycle
- Sedentarism – long trips or being sedentary at work
- Tuberculosis – tuberculous epididymitis can sometimes appear, especially in people with a compromised immune system
Symptoms of epididymitis
Symptoms of epididymitis may include:
- Swelling of the scrotum, redness and local increase in temperature (warm sensation to the touch)
- Testicular pain and tenderness
- Urgent need to urinate
- Pain when urinating
- Pain during ejaculation or during sexual intercourse
- Penile discharge
- Pain in the lower part of the abdomen or in the pelvic area
- Blood in semen
- Rarely, fever
Besides these symptoms, there are a number of peculiarities, depending on the type of epididymitis or its cause. Thus, chronic epididymitis, which lasts more than six weeks, is recurrent, and the symptoms may appear gradually.
In general, pain is common in all types of epididymitis. Even if testicular pain is unilateral, it can spread to the contralateral testicle.
If it is a bacterial epididymitis, symptoms may include nausea, fever, pain when urinating and even blood in the urine. When the bacteria have penetrated through the urethra, there is a greater possibility that the pathogen will be transmitted sexually.
In the case of acute epididymitis, the symptoms persist for less than six weeks and consist mainly of pain and swelling.
It is very important to know that the symptoms of epididymitis can be similar to those of testicular torsion, a condition also manifested by the twisting of the testicle and the interruption of the blood supply, which is why specialist diagnosis is vital.
Epididymitis in children
Cases of epididymitis in children are rare, but they can occur. In general, scrotal pain in children can be caused by:
- Direct trauma in the groin area
- Urinary infections that spread to the epididymis
- Urine reflux in the epididymis
- Twisting of the epididymis
In rare cases, epididymitis in children can be caused by:
- Mumps
- Tuberculosis
- Structural problems of the urinary tract
- Behcet’s disease
- Congenital kidney defects
- Fungal infections
Epididymitis in children is manifested by:
- Discomfort in the pelvis or lower abdomen
- Discharge from the urethra
- Burning or pain when urinating
- Redness in the area of the testicles
- Tenderness of the scrotum
- Fever
The difference between epididymitis and orchitis
Epididymitis occurs as an inflammation of the epididymis, while orchitis is an inflammation of the testicles. However, in the advanced stages of epididymitis, the infection can reach the testicles, causing orchitis. The latter appears spontaneously and disappears just as quickly.
Also, if epididymitis is caused mainly by bacterial infections, orchitis can appear as a result of a bacterial or viral infection, and most of the time, the mumps virus, which is part of the paramyxovirus family, is responsible.
In addition, in the case of epididymitis, the pain is mild to moderate, while for orchitis, experts speak of moderate to severe pain. Tenderness and swelling of the scrotal area are common to both conditions.
Complications of epididymitis
Left untreated, epididymitis can lead to the following complications:
- Abscess in the scrotal area
- Chronic epididymitis – the infection persists even in the absence of bacteria
- Epididymo-orchitis, if the disease spreads to the testicles
- Testicular atrophy
- Rarely, infertility due to the destruction of the epididymis and testicles
- The spread of the infection in other areas of the body
Diagnostic
The doctor establishes the diagnosis based on the symptoms, the medical, surgical and sexual history, the physical examination, as well as the investigations. Below are the main tests recommended in the diagnosis of scrotal pain:
- Urine analysis, to see if there are bacteria – these could indicate a possible urinary infection that has spread to the epididymis
- Testing a sample taken from the urethra or discharge from the penis
- Blood tests, to see if it is a sexually transmitted disease
- Imaging tests, to measure the blood flow in the testicles – in general, a color Doppler ultrasonography is recommended. This can determine if the blood flow from the testicles is lower or higher than normal. If it is smaller, it may indicate testicular torsion
- C-reactive protein testing – helps differentiate between epididymitis and testicular torsion. Also, the sedimentation rate of erythrocytes is increased, in the case of epididymitis
Treatment
The treatment of epididymitis starts from treating the cause of the infection. In general, they are recommended:
- antibiotics – administered for 1-2 weeks, depending on the pathogen that caused the infection (for example, doxycycline or ceftriaxone for Neisseria gonorrhoeae infection
- pain medication (analgesics)
- anti-inflammatory medication – to reduce inflammation
In addition to these drugs, most doctors also recommend:
- Bed rest and scrotal elevation for at least two days
- Application of cold compresses in the scrotal area
- Wearing a protective cup for support
- Avoiding lifting heavy objects
If an abscess has formed in the area of the testicles, the doctor will remove the liquid with the help of a syringe or through a minor surgical intervention.
The operation is the only solution, if the other treatments do not give results. The intervention involves the partial or total removal of the epididymis. Also, if the condition was caused by a defect in the urinary tract, the operation could correct it and, thus, the epididymitis symptoms would also improve.
Recovery and perspective
Most of the time, the treatment is effective in curing scrotal pain. Sometimes, the discomfort improves in a few weeks, but most cases of epididymitis heal in no more than three months.
In order to establish the clinical evolution, the doctor supervises the patient 3-7 days after the start of the treatment. Prepubescent boys must go to a urologist because there is an increased risk of urogenital abnormalities.
If the epididymitis appeared due to a sexually transmitted infection, both partners must refrain from sexual contact, until the end of the antibiotic treatment and complete healing.
In most cases, there are no adverse effects that influence sexual life or reproductive activity. There is, however, a risk of recurrence, which is why taking measures to prevent infection is indicated.
Prevention
You can prevent the occurrence or recurrence of scrotal pain by following these tips:
- Use a condom during sex
- Avoid intense physical exercises or lifting heavy objects
- Limits sedentarism
- Pay attention to the hygiene of the groin area
- Avoid sexual contact with partners who have sexually transmitted infections
