What is epididymitis and how is it treated?

What is Epididymitis?

Epididymitis is a painful bacterial infection causing swelling of the coiled tube (epididymis) that sits behind your testicle and stores sperm. 1, 2

How It Happens

• The infection typically occurs when bacteria travel backward through the tube that carries sperm (vas deferens) from your urethra to the epididymis 3, 4
• In men under 35 years old, the infection is usually caught during sex—most commonly from gonorrhea or chlamydia bacteria 1, 2, 5
• In men over 35 years old, the infection typically comes from urinary tract bacteria (like E. coli) that back up into the epididymis, often because of prostate enlargement or other urinary blockages 1, 2, 5
• In men who are the receptive partner during anal sex, intestinal bacteria can cause the infection 1, 2

What You'll Feel

• Pain and swelling develop gradually on one side of your scrotum, usually starting in the back part where the epididymis sits 1, 5
• The affected testicle becomes tender to touch, and you may notice fluid buildup around it 1
• You might have burning during urination or need to urinate more frequently, though these symptoms can be absent 1, 5
• Fever may occur in more severe cases 1

How It's Treated

For Men Under 35 (Sexually Transmitted)

• You'll receive one injection of ceftriaxone (250 mg) in your buttock or thigh, plus doxycycline pills (100 mg) taken twice daily for 10 days 1, 2, 6
• This combination kills both gonorrhea and chlamydia bacteria 1, 3
• If you engage in receptive anal intercourse, you'll get the ceftriaxone injection plus levofloxacin (500 mg once daily) or ofloxacin (300 mg twice daily) for 10 days instead, to cover intestinal bacteria 1, 2, 5

For Men Over 35 (Urinary Bacteria)

• You'll take oral antibiotics only—either levofloxacin (500 mg once daily) or ofloxacin (300 mg twice daily) for 10 days 1, 2
• These fluoroquinolone antibiotics target the urinary bacteria causing your infection 1, 2

Home Care That Helps

• Stay in bed with your scrotum elevated on a rolled towel or wear supportive underwear until the fever and swelling go down 1, 2
• Take pain relievers as prescribed to manage discomfort 1, 2
• The pain and swelling should start improving within 3 days of starting antibiotics 1, 2

Critical Rules to Follow

• Complete all 10 days of antibiotics even when you feel better—stopping early can lead to chronic pain, infertility, or treatment failure 2, 5
• Avoid all sexual activity until both you and your partner(s) finish treatment and have no symptoms 2
• All sexual partners from the past 60 days must get tested and treated if your infection is sexually transmitted, even without symptoms 1, 2

When to Seek Emergency Care

• If pain becomes sudden and severe, go to the emergency room immediately—this could be testicular torsion (a twisted testicle), which is a surgical emergency that can cause permanent damage within hours 1, 2
• Return to your doctor within 3 days if pain, swelling, or fever don't improve, as this requires changing your diagnosis or treatment 1, 2
• If swelling persists after completing antibiotics, you need comprehensive reevaluation for tumor, abscess, or other serious conditions 1, 2

Additional Testing You'll Need

• Your doctor will test for gonorrhea and chlamydia using a urine sample or urethral swab 1, 2
• HIV and syphilis testing are recommended since sexually transmitted epididymitis indicates risk for other infections 1, 2
• A urine culture may be done to identify specific bacteria, especially in men over 35 1

Common Mistakes to Avoid

• Don't assume you're cured when pain improves—the full 10-day antibiotic course is essential to prevent complications like chronic scrotal pain and infertility 2, 5
• Don't resume sex before completing treatment and confirming your partner is treated, as this spreads infection and worsens your condition 2
• Don't ignore worsening symptoms—untreated epididymitis can lead to abscess formation, testicular damage, and permanent fertility problems 5