Is epididymitis (inflammation of the epididymis) involved in progressive pain?

From the Guidelines

Yes, epididymitis typically involves pain that progresses over several days. This condition is characterized by inflammation of the epididymis, the coiled tube at the back of the testicle that stores and carries sperm. The pain usually begins gradually and worsens over 1-3 days, often starting at the back of one testicle and potentially spreading to the entire scrotum.

Key Characteristics of Epididymitis

• Inflammation of the epididymis
• Pain that progresses over several days
• Often caused by bacterial infections such as C. trachomatis or N. gonorrhoeae 1
• Can also be caused by non-sexually transmitted pathogens, especially in men over 35 years old 1

Treatment and Management

Treatment typically includes antibiotics if the cause is bacterial, such as doxycycline 100mg twice daily for 10 days for sexually transmitted infections or ciprofloxacin 500mg twice daily for 10 days for urinary tract pathogens.

• Pain management with NSAIDs like ibuprofen 400-600mg three times daily
• Scrotal support and rest are important supportive measures
• Ice packs can help reduce swelling As noted in the guidelines, empiric therapy is indicated before culture results are available, and treatment of epididymitis caused by C. trachomatis or N. gonorrhoeae will result in a microbiologic cure of infection, improvement of signs and symptoms, prevention of transmission to others, and a decrease in potential complications 1. The gradual onset of pain distinguishes epididymitis from testicular torsion, which causes sudden severe pain and requires emergency intervention. Epididymitis occurs when bacteria travel from the urethra or bladder to the epididymis, causing inflammation and the characteristic progressive pain pattern.

From the FDA Drug Label

Acute epididymo-orchitis caused by N. gonorrhoeae: 100 mg, by mouth, twice a day for at least 10 days. Acute epididymo-orchitis caused by C. trachomatis: 100 mg, by mouth, twice a day for at least 10 days

The condition epididymo-orchitis, which involves epididymitis, is typically treated for at least 10 days, indicating that the pain associated with this condition can progress over several days. The treatment duration suggests that the condition may require an extended period to resolve, which can involve ongoing pain management 2.

• Key points:
  • Epididymo-orchitis treatment lasts for at least 10 days
  • Epididymitis is involved in this condition
  • Pain can progress over several days due to the nature of the condition and its treatment duration

From the Research

Epididymitis and Pain Progression

• Epididymitis is characterized by the gradual onset of posterior scrotal pain that may be accompanied by urinary symptoms such as dysuria and urinary frequency 3.
• The pain associated with epididymitis can progress over several days, and it is often accompanied by swelling and tenderness of the epididymis 4.
• The progression of pain in epididymitis can be influenced by various factors, including the underlying cause of the infection, the presence of complications, and the effectiveness of treatment 5.

Causes of Epididymitis

• The most common causes of epididymitis include sexually transmitted infections (STIs) such as Chlamydia trachomatis and Neisseria gonorrhoeae, as well as urinary tract pathogens such as Escherichia coli 3, 4.
• In men over 35 years old, epididymitis is often caused by enteric bacteria transported by reflux of urine into the ejaculatory ducts secondary to bladder outlet obstruction 3.
• The choice of initial antibiotic regimen is empirical and based on the most likely causative pathogen, whether sexually transmitted, enteric, or other 6.

Diagnosis and Management

• The diagnosis of epididymitis is often based on clinical presentation, physical examination, and laboratory tests such as urine analysis and culture 4, 5.
• The management of epididymitis typically involves antibiotic therapy, with the choice of antibiotic depending on the suspected cause of the infection 3, 7, 6.
• It is essential to follow established clinical guidelines for the management of epididymitis to reduce patient morbidity and prevent complications such as infertility and chronic scrotal pain 3, 7.