Clinical Information on Epididymitis

Basic data


  • Epididymitis


  • Less than 1 case per 1,000 patients per year, but exact figures are not available
  • Rare before sexually mature age

Etiology and pathogenesis

  • In younger men are sexually transmitted infection most frequently
    • Chlamydia trachomatis, less often Neisseria gonorrhoeae
  • In men over 35 years most gram-negative rods
  • Can also be a complication of underlying urological disease, or recent instrumentation
  • A non-infectious variant can occur 2-3 days after trauma
  • At the same time swelling in the testicle due to edema

predisposing factors

  • Recurrent epididymit in younger boys may be due to reflux of urine to the seminal vesicles
  • Testicular cancer can in rare cases cause


  • Y74 Inflammation of the testis / epididymis


  • N45 Inflammation of the testis and epididymis
  • N450 Orchitis, epididymitis electricity epididymoorkitis m abscess
  • N459 Orchitis, epididymitis electricity epididymoorkitis without abscess


diagnostic criteria

  • Pain in the scrotum and palpable swelling and tenderness of the epididymis
  • Possibly. ultrasound examination can confirm the diagnosis


  • Testicular torsion (funikeltorsion) – more acute onset of symptoms
  • tumor testis
  • Layer from external genitalia
  • orchitis
  • Varicocele – no soreness

Medical history

  • Slow onset of heaviness and pain in the scrotum, rays often up in the abdomen
  • Chills, temperature increase to 39-40 ° C, swelling and tenderness at one epididymis
  • At the same time burning and frequent urination, sometimes discharge

clinical findings

  • Swelling, redness and local heat, usually unilateral
  • Palpation of the epididymis, dorsal and cranial to the testicle, and funiklen is very painful
  • Fever occurs frequently, there may be malaise
  • At the same time cystit- or uretrit symptoms occur
  • Prehns characters: by lifting the scrotum pain relief is obtained by epididymitis, while this will not lead to relief by testicular torsion

Additional studies in general practice

  • Inoculation of the urethra in order to chlamydia and gonorrhea
  • In men over 35 years: midstream urine to stixundersøgelse and cultivation
  • Blood tests provide little additional information
    • CRP , and leucocytes SR may be elevated

other studies

  • Ultrasound examination to substantiate the diagnosis, especially if you are unsure whether there is abscess formation, or any. funikeltorsion
  • Urography and cystoscopy is only indicated for suspected underlying urinary tract disease

When to refer the patient?

  • At high fever and malaise patient should be admitted to hospital
  • If testicular torsion or cancer can not be excluded


Treatment goals

  • The elimination of the infection

Generally about the treatment

  • Antibiotics and ro

What can the patient do?

  • Bed rest and analgesics will relieve the first days
  • Possibly. suspensorium which stabilizes the testicles

Medical treatment

  • Men under 35 – or suspected sexually transmitted disease in men over 35 years are treated as sexually transmitted disease:
    • Azithromycin  1 g as engangsdose or 500 mg a day for 3 days
    • Doxycycline  100 mg x 2 for 7 days is an alternative
  • Men over 35-40 years
    • Ampicillin  500mg x 3 for 2 weeks – or
    • Mecillinam  400mg x 3 for 2 weeks –
    • Ciprofloxacin 500 mg x 2 for 10-14 days
  • Appendix with NSAIDs has been reported to be effective

Course, complications and prognosis


  • The condition develops slowly. The patient can after the acute phase having swelling in the scrotum for weeks to months


  • Cyst formation in the epididymis
  • sterility


  • Possibility of sterility is present
  • From time to develop cysts in the epididymis

patient Information

What are the written patient information

  • Information about epididymitis
  • About antibiotics



  • The patient should be checked after one month
  • By not sexually transmitted disease and lack of response to treatment, urological investigation topical
  • If palpationsfundet not quite normal, it is ordered ultrasound examination of the scrotum / testicles

What should be checked

  • Bacteriological investigation after evidence sexually transmissible disease
  • Treatment and follow-up of potential partners
  • Exclude underlying testicular
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