Could Your Symptoms Indicate an Infection?
Your constellation of symptoms—yellow semen, erectile dysfunction, low libido, reduced ejaculate volume, and subsequent testicular atrophy—strongly suggests you may have had epididymitis or epididymo-orchitis that was either untreated or inadequately treated, potentially leading to chronic inflammation and testicular damage.
Understanding the Clinical Picture
Your symptoms align with a pattern of genitourinary infection that progressed to cause structural damage:
Yellow semen can indicate the presence of white blood cells (pyospermia) from an inflammatory or infectious process in the reproductive tract 1
Erectile dysfunction and low libido are recognized complications of chronic genitourinary infections and can result from both the inflammatory process itself and the psychological impact of chronic testicular pain 1
Low ejaculate volume suggests involvement of the seminal vesicles or obstruction in the genital tract, which commonly occurs with epididymitis when inflammation extends proximally 1
Testicular atrophy is a serious sequela that indicates prolonged inflammation caused permanent damage to testicular tissue, which can occur when epididymitis or orchitis is left untreated or treatment is delayed 1
Most Likely Infectious Causes
The specific pathogens depend heavily on your age and sexual activity:
If You Were Under 35 Years Old When Symptoms Began:
Chlamydia trachomatis is the most common cause of sexually transmitted epididymitis in younger men, accounting for the majority of cases 1, 2, 3
Neisseria gonorrhoeae is the second most common sexually transmitted pathogen causing epididymitis 1, 2
These infections typically present with urethritis (which can be asymptomatic in up to 50% of cases), followed by ascending infection to the epididymis 1, 4
Chlamydia was found in 12.3% of men under 35 diagnosed with epididymitis/orchitis in emergency department settings 3
If You Were Over 35 Years Old:
Escherichia coli and other enteric bacteria are the predominant causes, usually associated with urinary tract abnormalities or bladder outflow obstruction 1, 2, 3
E. coli was the most common bacteria isolated in urine cultures from men with epididymitis/orchitis, followed by Streptococcus, Klebsiella, Pseudomonas, and Serratia 3
These infections often occur in the context of prostate enlargement, urinary retention, or recent urological procedures 2, 4
Why Testicular Atrophy Developed
Testicular atrophy following your other symptoms is a critical finding that indicates several possible scenarios:
Untreated or inadequately treated epididymitis can progress to involve the testis itself (epididymo-orchitis), causing direct inflammatory damage to testicular tissue 5, 2, 4
Chronic inflammation lasting more than 3 months can lead to fibrosis and permanent testicular damage 5
Vascular compromise from severe inflammation can cause testicular infarction and subsequent atrophy 1
Abscess formation is a potential complication when treatment fails, which can destroy testicular parenchyma 1
In cases of azoospermia with testicular atrophy and elevated FSH (>7.6 IU/L), spermatogenic failure from prior infection is a recognized cause 1
Critical Diagnostic Considerations You Should Have Received
The evaluation for epididymitis should have included 1:
Gram-stained smear of urethral exudate or intraurethral swab to identify urethritis (≥5 polymorphonuclear leukocytes per oil immersion field)
Nucleic acid amplification testing (NAAT) for N. gonorrhoeae and C. trachomatis on urethral swab or first-void urine
Urinalysis and urine culture to identify enteric bacteria, particularly if urethral Gram stain was negative
Scrotal ultrasound with Doppler would have shown enlarged, tender epididymis with increased blood flow, hydrocele, and scrotal wall thickening 1, 6
Syphilis serology and HIV testing should have been offered as part of comprehensive STI screening 1
What Should Have Been Done Differently
Failure to improve within 3 days of starting antibiotics requires immediate reevaluation of both diagnosis and therapy 1. The development of testicular atrophy suggests either:
- Treatment was never initiated
- Wrong antibiotics were used for the causative organism
- Treatment duration was insufficient (standard is 10 days minimum for acute epididymitis) 1
- Complications developed that required more aggressive intervention 1
Swelling and tenderness persisting after completion of antimicrobial therapy should prompt comprehensive evaluation for tumor, abscess, infarction, testicular cancer, or tuberculous/fungal epididymitis 1
Common Pitfalls That May Have Occurred
Only 50.1% of men diagnosed with epididymitis/orchitis in emergency departments are actually tested for gonorrhea and chlamydia, representing a major gap in care 3
Only 62.1% receive urine cultures, missing potential bacterial causes 3
Testicular torsion must be ruled out urgently in any case of acute testicular pain, as it requires surgical intervention within 6-8 hours to prevent testicular loss 1, 6
Patients are often not given adequate instructions to avoid sexual intercourse until both they and their partners complete treatment and are symptom-free 1
What You Should Do Now
Given that you have already developed testicular atrophy, you need comprehensive evaluation:
Semen analysis to assess current fertility status and document degree of impairment 1
Hormone testing including FSH, LH, and testosterone to evaluate testicular function 1
Scrotal ultrasound to assess current testicular size, echogenicity, and rule out other pathology like tumors or chronic inflammation 1
Genetic testing (karyotype and Y-chromosome microdeletion) if you have azoospermia or severe oligospermia with elevated FSH, as this helps distinguish infection-related damage from genetic causes 1
Urological consultation for comprehensive evaluation and discussion of fertility preservation options if needed 1
STI screening if not previously done, including testing for chlamydia, gonorrhea, syphilis, and HIV 1
The presence of testicular atrophy following your symptom complex strongly indicates that an infectious/inflammatory process occurred and caused permanent damage, most likely because it was not recognized or adequately treated in time.