From the Guidelines
Epididymitis and testicular cancer are two distinct conditions that require different approaches to diagnosis and treatment, with epididymitis typically presenting with pain and responding to antibiotics, while testicular cancer often presents as a painless mass requiring prompt surgical intervention.
Key Differences
- Epididymitis is an inflammation of the epididymis, usually caused by bacterial infections, and its symptoms include gradual onset of pain, swelling, redness, and warmth in the scrotum, often accompanied by fever, urinary symptoms, and discharge 1.
- Testicular cancer, on the other hand, is a malignancy of the testicle itself, presenting as a painless lump or swelling, heaviness in the scrotum, and sometimes a dull ache, with a rising incidence over recent decades 1.
Diagnosis and Treatment
- Epididymitis treatment involves antibiotics such as doxycycline 100mg twice daily for 10 days or ciprofloxacin 500mg twice daily for 10 days, along with pain management, rest, and scrotal support.
- Testicular cancer requires prompt medical attention for diagnosis through ultrasound and blood tests, followed by surgical removal of the affected testicle and possibly additional treatments like radiation or chemotherapy depending on the cancer stage, with current evidence suggesting that optimal outcomes are obtained in high-volume reference centres 1.
Importance of Prompt Diagnosis
- Given the excellent 5-year relative survival rate for testicular cancer (94%) when diagnosed and treated promptly 1, it is crucial to differentiate between epididymitis and testicular cancer to ensure appropriate and timely treatment.
- The global incidence of testicular cancer has been steadily rising, with an estimated 9,720 new cases projected to be diagnosed in the United States in 2025, highlighting the need for awareness and prompt medical evaluation for any testicular abnormalities 1.
From the Research
Epididymitis vs Testicular Cancer: Key Differences
- Epididymitis is characterized by inflammation of the epididymis, typically presenting with gradual onset of posterior scrotal pain, urinary symptoms, and a swollen, tender epididymis 2.
- The etiology of epididymitis varies by age group, with Neisseria gonorrhoeae and Chlamydia trachomatis being the most common pathogens in sexually active males 14 to 35 years of age 2, 3.
- In contrast, testicular cancer is a type of cancer that affects the testicles, with different symptoms and treatment options.
- While epididymitis can be treated with antibiotics, such as ceftriaxone and doxycycline, or ofloxacin and levofloxacin 2, 3, testicular cancer requires a different approach.
Diagnostic Considerations
- Epididymitis and orchitis can be differentiated from testicular torsion, a surgical emergency, based on the gradual onset of scrotal pain and symptoms of lower urinary tract infection, including fever 3.
- Laboratory studies, such as urethral Gram stain, urinalysis and culture, and polymerase chain reaction assay for C. trachomatis and N. gonorrhoeae, can help guide therapy for epididymitis 3.
- The diagnosis and management of epididymitis can be challenging, relying on clinical expertise and established clinical guidelines 4.
Treatment and Management
- Untreated acute epididymitis can lead to infertility and chronic scrotal pain, making recognition and therapy vital to reduce patient morbidity 2.
- The treatment of epididymitis depends on the underlying cause, with antibiotics being the primary treatment option for bacterial infections 2, 3.
- In cases where the etiology is unknown, treatment may be empirical, targeting the most common pathogens 3.