Signs and Symptoms of Epididymitis
Epididymitis characteristically presents with unilateral testicular pain and tenderness, accompanied by palpable swelling of the epididymis, and often a hydrocele. 1
Primary Clinical Features
Pain Characteristics
- Gradual onset of posterior scrotal pain is the hallmark presentation, distinguishing it from the sudden severe pain of testicular torsion 2, 3
- Pain is almost always unilateral in acute epididymitis 4
- The discomfort typically begins at the lower pole of the epididymis and progresses upward toward the head at the upper pole 5
Physical Examination Findings
- Palpable swelling and tenderness of the epididymis is consistently present 6, 1
- Hydrocele formation commonly accompanies the inflammation 6, 1
- The testis remains in its normal anatomic position with an intact ipsilateral cremasteric reflex, helping differentiate from torsion 3
- The epididymis feels swollen and tender on palpation 5
Associated Symptoms
Urinary Tract Symptoms
- Dysuria (painful urination) frequently accompanies epididymitis 2
- Urinary frequency is a common associated symptom 2
- Lower urinary tract infection symptoms, including fever, may be present 3
Systemic Signs
- Fever may develop in more severe cases 1
- Patients who are febrile or systemically unwell require more aggressive management 5
Critical Differential Diagnosis Warning
Testicular torsion must be excluded immediately, as it is a surgical emergency that occurs more frequently in adolescents and presents with sudden onset of severe pain without evidence of inflammation or infection 6, 1. Emergency consultation is required when pain onset is sudden, pain is severe, or initial testing does not support urethritis or urinary tract infection, because testicular viability becomes compromised within 4-6 hours 6, 5.
Associated Infectious Signs
In Sexually Active Men <35 Years
- Urethritis (often asymptomatic) typically accompanies sexually transmitted epididymitis 6
- Urethral discharge may be present if gonococcal or chlamydial infection is the cause 2, 7