Epididymitis

What is epididymitis?

Epididymitis is inflammation of the epididymis, the coiled tube that sits behind each testicle and stores and carries sperm. When this tube becomes irritated or infected, it can swell and become painful, usually on one side of the scrotum (the pouch of skin that holds the testicles). Understanding what is epididymitis begins with knowing that it is one of the most common causes of scrotal pain in adult men, and in most cases it is treatable, especially when it is recognized early.

Epididymitis can affect males of any age, from young boys to older men, but it is seen most often in adults between roughly 18 and 50 years of age. In younger, sexually active men, it is frequently linked to sexually transmitted infections. In older men, it is more often related to urinary tract infections or problems with urine flow, such as an enlarged prostate (the gland that surrounds the urethra, the tube that carries urine out of the body).

Doctors often describe two main forms of the condition. Acute epididymitis develops over hours to days and typically lasts less than six weeks. Chronic epididymitis refers to discomfort or pain in the epididymis that lasts six weeks or longer, sometimes with less obvious swelling. When the inflammation spreads to involve the testicle itself, the condition is called epididymo-orchitis. In hospital coding systems, epididymitis is classified under ICD-10 code N45.1.

Symptoms of epididymitis

Epididymitis symptoms usually begin gradually, often over a day or two, which helps distinguish the condition from some other causes of scrotal pain that start very suddenly. The discomfort is typically felt on one side, although both sides can occasionally be affected.

Common epididymitis symptoms include:

• Pain and tenderness in one side of the scrotum, often starting at the back of the testicle and sometimes spreading to the whole testicle or the groin
• Swelling of the scrotum on the affected side, which may feel warm to the touch
• Redness or a feeling of heat in the skin of the scrotum
• Pain or burning when urinating, or a need to urinate more often or more urgently
• Discharge (fluid) from the penis, particularly when a sexually transmitted infection is the cause
• Fever or chills in more significant infections
• Discomfort during sexual activity or ejaculation, or blood in the semen in some cases
• A lump or firm, tender area behind the testicle where the epididymis lies

Symptoms can differ depending on the stage and type of the condition. In acute epididymitis, pain, swelling, and urinary symptoms tend to be more pronounced, and fever is more likely. In chronic epididymitis, men often describe a dull, nagging ache or heaviness in the scrotum that comes and goes over weeks or months, sometimes without visible swelling or urinary symptoms. In boys, epididymitis may follow a viral illness or minor trauma and can present mainly as scrotal pain and reluctance to walk normally.

It is important to know that severe scrotal pain that begins very suddenly, especially in boys and young men, may instead be caused by testicular torsion, a twisting of the testicle that cuts off its blood supply. Torsion is a surgical emergency, and because it can be difficult to tell the two conditions apart without an examination, sudden severe scrotal pain should always be assessed urgently by a doctor.

Causes and risk factors

Epididymitis causes vary with age and circumstances, and identifying the likely cause helps guide treatment. The most common causes include:

• Sexually transmitted infections (STIs): In sexually active men, particularly those under about 35, bacteria such as chlamydia and gonorrhea are frequent causes. These infections often begin in the urethra and travel back along the reproductive tract to the epididymis.
• Urinary tract infections: In older men and in boys, bacteria that normally cause bladder or kidney infections, such as E. coli, can spread to the epididymis. This is more likely when urine does not flow freely, for example because of an enlarged prostate or a narrowing of the urethra.
• Urine reflux: In some cases, urine flows backward into the tubes leading to the epididymis, causing a chemical (non-infectious) inflammation. This can happen with heavy lifting or straining.
• Medical procedures and catheters: Recent urinary catheter use (a tube placed to drain urine), cystoscopy (a camera examination of the bladder), or prostate surgery can introduce bacteria or irritate the urinary tract.
• Trauma: A direct injury to the groin can inflame the epididymis.
• Certain medications and conditions: The heart medication amiodarone is a recognized non-infectious cause. Tuberculosis, mumps, and some inflammatory conditions can also involve the epididymis, although these are less common.

Risk factors that make epididymitis more likely include unprotected sex or a new sexual partner, a personal history of STIs or urinary tract infections, an uncircumcised penis in some age groups, structural abnormalities of the urinary tract, an enlarged prostate, recent urinary tract procedures, and prolonged sitting or activities that put pressure on the groin. In many cases, however, no single clear cause is found, particularly in chronic epididymitis.

Diagnosis

Epididymitis diagnosis starts with a careful medical history and a physical examination. Your doctor will ask about how and when the pain started, urinary symptoms, sexual history, recent illnesses or procedures, and any injury. During the examination, the doctor gently checks the scrotum for swelling, warmth, and tenderness, and assesses whether the tenderness is centered on the epididymis, the testicle, or both. The prostate may also be examined if a urinary source is suspected.

Because the priority is to rule out testicular torsion and other serious conditions, doctors often use a combination of the following tests:

• Urine tests: A urinalysis and urine culture look for signs of infection and identify the bacteria involved, which helps target antibiotic treatment.
• STI testing: In sexually active men, urine samples or urethral swabs are commonly tested for chlamydia and gonorrhea.
• Scrotal ultrasound with Doppler: This painless imaging test uses sound waves to view the scrotum and measure blood flow. In epididymitis, blood flow to the affected side is typically normal or increased, whereas in testicular torsion it is reduced or absent. Ultrasound can also help exclude an abscess (a collection of pus) or, rarely, a tumor.
• Blood tests: These may be used to look for signs of infection or inflammation, particularly if fever is present or the illness seems severe.

There is no single test that confirms epididymitis on its own; doctors combine the history, examination findings, urine and STI results, and imaging to reach the diagnosis and to identify the likely cause. In children and in men with repeated episodes, additional imaging of the urinary tract may be considered to look for structural problems.

Treatment options

Epididymitis treatment depends on the likely cause, the severity of symptoms, and the patient’s age. Most cases are managed successfully without surgery. Care for this condition is typically provided by a urology department, the medical specialty that deals with the urinary tract and male reproductive organs; at Acibadem, epididymitis is managed within urology, and further details about the condition are available on its epididymitis page.

Antibiotics

Because most acute cases are caused by bacterial infection, antibiotics are the mainstay of treatment. The choice of antibiotic depends on the suspected source: regimens aimed at chlamydia and gonorrhea are often used in younger, sexually active men, while antibiotics targeting common urinary bacteria are usually chosen for older men or those with urinary tract problems. Courses commonly last around one to two weeks, and it is important to finish the full course even if symptoms improve quickly. If an STI is confirmed or strongly suspected, recent sexual partners generally need testing and treatment as well, and sexual activity is usually avoided until treatment is complete for everyone involved.

Supportive care and pain relief

Alongside antibiotics, doctors usually recommend measures to ease discomfort while the inflammation settles:

• Rest, with reduced physical activity and avoidance of heavy lifting for a period
• Scrotal support and elevation, for example supportive underwear or a rolled towel under the scrotum when lying down
• Cold packs applied to the scrotum (wrapped in cloth, for short periods) to reduce swelling
• Anti-inflammatory pain relievers, such as ibuprofen, when appropriate for the individual patient
• Drinking adequate fluids to support the urinary tract

Watchful waiting and non-infectious cases

When epididymitis is caused by a virus, a medication, urine reflux, or minor trauma rather than bacteria, antibiotics may not be needed. In these situations, your doctor may recommend supportive care and monitoring while the inflammation resolves on its own. In chronic epididymitis, where infection is often absent, treatment focuses on anti-inflammatory medication, scrotal support, and sometimes nerve-related pain treatments; management is individualized and may take time.

Procedures and surgery

Surgery is not needed for most patients, but it may be considered in specific circumstances. If an abscess forms, it may need to be drained. In rare, severe, or repeatedly recurring cases that do not respond to other treatments, surgical removal of the epididymis (epididymectomy) may be discussed, although results for chronic pain are variable and this option is weighed carefully. If a structural urinary problem is contributing, such as significant prostate enlargement or a urethral narrowing, treating that underlying issue can help prevent further episodes.

With appropriate epididymitis treatment, pain and fever often begin to improve within a few days, although swelling and tenderness can take several weeks to fully resolve. A follow-up visit is often advised to confirm that the infection has cleared, particularly if symptoms persist.

Living with epididymitis and outlook

For most men, the outlook after acute epididymitis is good. When the condition is diagnosed promptly and treated appropriately, the infection usually clears and the epididymis returns to normal over a period of weeks, though a feeling of firmness or mild tenderness can linger for some time. Recovery is not always linear, and it is common for discomfort to fluctuate before settling.

Some men develop chronic epididymitis, with ongoing or recurring scrotal discomfort. This can be frustrating, but symptoms can often be managed with a combination of anti-inflammatory measures, scrotal support, activity adjustments, and follow-up care. If pain persists, further evaluation helps exclude other causes and refine the treatment plan.

Possible complications of untreated or severe epididymitis include abscess formation, spread of infection to the testicle (epididymo-orchitis), shrinkage of the affected testicle, and, uncommonly, reduced fertility if both sides are damaged. These outcomes are not typical, and prompt treatment lowers the risk considerably, although no treatment can guarantee a specific result.

Steps that may reduce the chance of another episode include practicing safer sex (using condoms and limiting exposure to untreated STIs), treating urinary tract infections promptly, addressing prostate or urinary flow problems, emptying the bladder fully and regularly, and avoiding prolonged pressure or repeated strain on the groin where possible. Men who have had one episode should be alert to early symptoms so that any recurrence can be treated quickly.

Frequently asked questions

What is epididymitis in simple terms?

Epididymitis is swelling and irritation of the epididymis, the small coiled tube behind each testicle that stores sperm. It is most often caused by a bacterial infection, either a sexually transmitted infection in younger men or a urinary infection in older men, and it usually causes pain and swelling on one side of the scrotum. In most cases it responds well to antibiotics and supportive care.

How serious is epididymitis?

Most cases are not dangerous when treated promptly, and the majority of men recover fully. However, untreated epididymitis can occasionally lead to an abscess, spread of infection to the testicle, or long-term damage that may affect fertility if both sides are involved. Because its symptoms can resemble testicular torsion, a true emergency, any significant scrotal pain should be evaluated by a doctor rather than managed at home.

Can epididymitis heal on its own?

Some mild, non-infectious cases, such as those caused by minor trauma or urine reflux, may settle with rest and supportive care alone. However, bacterial epididymitis generally requires antibiotics, and waiting without treatment risks complications. Since it is difficult to know the cause without testing, it is safest to have symptoms assessed rather than assuming they will pass.

How long does recovery from epididymitis take?

With appropriate treatment, pain and fever often begin to improve within a few days, but full recovery usually takes longer. Swelling and tenderness in the epididymis can persist for several weeks, and in some men a degree of firmness remains even after the infection has cleared. If symptoms have not improved after finishing antibiotics, a follow-up assessment is generally recommended.

Is epididymitis always caused by a sexually transmitted infection?

No. While chlamydia and gonorrhea are common causes in sexually active younger men, epididymitis in older men and boys is more often caused by ordinary urinary bacteria, urine reflux, recent urinary procedures, or, less commonly, viruses, medications, or trauma. Testing helps identify the cause so that treatment, and any partner testing, can be targeted appropriately.

Can epididymitis affect fertility?

In most cases treated promptly, fertility is not affected. Rarely, severe or repeated infections, especially if both epididymides are damaged or scarred, can interfere with the passage of sperm and reduce fertility. This is one reason doctors encourage early treatment and follow-up rather than waiting for symptoms to resolve on their own.

What is the difference between epididymitis and testicular torsion?

Epididymitis is inflammation of the tube behind the testicle and usually develops gradually over hours to days, often with urinary symptoms or fever. Testicular torsion is a sudden twisting of the testicle that cuts off its blood supply, typically causing abrupt, severe pain, often with nausea, and it requires emergency surgery within hours to save the testicle. Because the two can be hard to distinguish without an examination and ultrasound, sudden severe scrotal pain should always be treated as an emergency.

When to see a doctor

Any new scrotal pain or swelling deserves medical evaluation, because the causes range from mild inflammation to emergencies that need immediate treatment. Seek urgent medical care, including emergency care where appropriate, if you notice any of the following red-flag signs:

• Sudden, severe scrotal or testicular pain, especially if it started within minutes to a few hours — this may indicate testicular torsion, which must be treated within hours
• High fever, chills, or feeling very unwell alongside scrotal pain, which may signal a spreading infection
• Nausea or vomiting accompanying testicular pain
• Rapidly increasing swelling, marked redness, or skin changes of the scrotum
• Inability to urinate or blood in the urine
• Pain that does not improve or worsens despite treatment already prescribed
• A new lump in the testicle or scrotum, even if it is painless

Also arrange a routine medical appointment if you have milder but persistent scrotal discomfort, burning during urination, discharge from the penis, or symptoms that return after a previous episode of epididymitis. Early assessment allows the cause to be identified and treated before complications develop, and it provides the best chance of a full recovery.