Can Epididymitis Occur Bilaterally?
Epididymitis typically presents as a unilateral condition, with bilateral involvement being uncommon but possible. 1, 2
Typical Presentation Pattern
The CDC guidelines consistently describe epididymitis as presenting with unilateral testicular pain and tenderness, accompanied by palpable swelling of the epididymis and often a hydrocele. 1, 2
The characteristic clinical picture involves one-sided involvement, which is the expected presentation pattern that clinicians should anticipate when evaluating suspected epididymitis. 2
Recent research confirms that epididymitis "mostly occurs unilaterally" and may spread to the testis if untreated, becoming epididymo-orchitis. 3
Bilateral Cases
While bilateral epididymitis can occur, it is not the typical presentation pattern and should prompt consideration of alternative or additional diagnoses. 4
Chronic epididymitis specifically may present with "unilateral or bilateral testicular, epididymal, or scrotal pain" as the sole presenting symptom, suggesting that bilateral involvement is more commonly seen in chronic rather than acute cases. 4
When bilateral symptoms are present, clinicians should maintain a broader differential diagnosis and consider whether other pathologic processes may be contributing to the clinical picture. 4
Clinical Implications
The unilateral nature of typical epididymitis is a key distinguishing feature that helps differentiate it from testicular torsion (which also presents unilaterally) and other scrotal pathology. 1, 2
If a patient presents with bilateral scrotal pain and swelling, the diagnosis of epididymitis should be made cautiously, with consideration of alternative diagnoses or concurrent pathology. 4
The presence of bilateral symptoms does not exclude epididymitis but should trigger a more comprehensive evaluation to ensure other conditions are not being missed. 4