Epididymitis is inflammation of the epididymis —the coiled tube that collects sperm from the testicle and passes it on to the vas deferens. There are two forms of this disease, acute and chronic. Acute epididymitis comes on suddenly with severe symptoms and subsides with treatment. Chronic epididymitis is a long-standing condition, usually of gradual onset, for which the symptoms can be improved with treatment but may not be completely resolved.
Orchitis is inflammation of the testicle or both testicles. It is almost always comes on very suddenly and subsides with treatment. Chronic orchitis is not well-defined, and instead is considered to be one of the many conditions related to chronic testicular pain.
Epididymo-orchitis is the sudden inflammation of both the epididymis and the testicles simultaneously.
Epididymitis and Orchitis Signs & Symptoms
Acute epididymitis symptoms occur not only from the local infection, but also from the original source of the infection. Common symptoms from the original source of the infection include: testicular pain, urethral discharge and urethral pain or itching, pelvic pain, urinary frequency, urinary urgency, painful/burning urination, fever, perineal pain, and flank pain. In some cases, pain in the scrotum from the local infection is the only noticeable symptom. The pain starts at the back of one testicle but can soon spread to the entire testicle, the scrotum and occasionally the groin. Swelling, tenderness, redness, firmness and warmth of the skin may also accompany the pain. In acute epididymitis the urine is usually infected with bacteria and may have symptoms of a urinary tract infection.
Chronic epididymitis symptom is dull pain only in the scrotal contents and is less severe and more localized than acute epididymitis. There is no swelling, tenderness, redness and warmth of the skin of the scrotum. Additional tests may be used as for acute epididymitis, but are less frequently required.
Symptoms of orchitis include pain of varying severity, tenderness and swelling in the tesicles. The parotiditis (swelling of facial glands) usually precedes orchitis by three to seven days. Isolated orchitis from bacterial infection has the same symptoms of acute epididymitis or epididymo-orchitits.
Epididymitis and Orchitis Diagnosis
To make the diagnosis, the doctor will ask you about your medical history and examine you. The doctor may test a urine sample to assess for bacterial infection, culture a urine sample as a more definitive way to see if there is bacterial infection, or examine a swab obtained from the urethra (if urethritis is suggested by your symptoms). If your pain came on very suddenly and severely, then an ultrasound, which is a non-invasive test that uses sound waves to look at the epididymis and measure blood flow, might be used to distinguish epididymitis from another condition called testicular torsion . This is managed very differently than epididymitis, so making the distinction is very important.
Epididymitis and Orchitis Treatment
General therapy for epididymitis includes bed rest for one to two days combined with elevation of the scrotum. The aim is to get the inflamed epididymis above the level of the heart. This improves blood flow out of the testicle, which promotes more rapid healing and reduces swelling and discomfort. Intermittent application of ice might also be of assistance and, in cases due to infection, intake of plenty of fluids. Nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen are useful since they not only relieve pain but also reduce the inflammation that is the cause of the pain.
Acute epididymitis and acute epididymo-orchitis: Treatment in cases suspected to be from bacteria (most) includes at least two weeks of antibiotics. Most cases can be treated with oral antibiotics as an outpatient. Your doctor may prescribe antibiotics if bacteria was present in any of the urine testing to treat the infection. In cases of severe infection with intractable pain, vomiting, very high fever or overall severe illness, may require admission to the hospital.
Chronic epididymitis Primary therapy is with medications and other treatments directed towards reducing the discomfort of the area. Non-steroidal anti-inflammatory medications and local application of heat are the mainstays of treatment. If symptoms persist, your physician may recommend other medications to alter the perception of pain in the area, or might refer you to a specialist in pain management. If all else fails the epididymis can be surgically removed (epididymectomy) while leaving the testicle in place.
There is no specific treatment for acute orchitis. In cases of bacterial infection, treatment is as for acute epididymitis and acute epididymo-orchitits.