Image of Kingston


Epididymo-orchitis in gay and bisexual men

What is epidiymo-orchitis?

  • Pain and swelling of the scrotum (ball bag) effecting the epididymis (epididymitis), the testicles (orchitis) or both (epididymo-orchitis).
  • In young men under the age of 35 years it is usually caused by a sexually transmitted infection e.g. chlamydia or gonorrhoea.
  • In older men over the age of 35 years it is usually caused by a non sexually transmitted infection causing urine infections.
  • Prompt medical assessment is needed to rule out the possibility of testicular torsion which can lead to testicular atrophy.
  • If you have epididymo-orchitis we recommend that you should have a full STI screen including an HIV test.
  • Epidiymo-orchitis is easily treated with antibiotics and rest.


How common is epididymo-orchitis?

  • It occurs most commonly in young men aged 19- 40 years.


How do you catch epididymo-orchitis?

  • In young men under the age of 35 years the most common cause is a sexually transmitted infection such as chlamydia or gonorrhoea.
  • In older men over the age of 35 years the most common cause is a urine infection – but it may also be caused by a sexually transmitted infection.
  • It may also be caused by bacteria caught during insertive anal intercourse.
  • Rarely epididymo-orchitis may be caused by other infections such as mumps or tuberculosis.


What would I notice if I had epididymo-orchitis?

  • A rapid onset of pain and swelling in one of your testicles.
  • Some men may also notice a discharge from the tip of the penis and/or pain on passing urine.
  • Occasionally you may feel generally unwell with a fever.


How do I get tested for epididymo-orchitis?

  • Epididymo-orchitis is diagnosed by a medical assessment, STI screen and urine test.
  • It will be treated immediately at your first visit to the clinic.
  • If there is any concern about a possible torsion of the testicles you will be referred immediately to the Accident & Emergency Department at Kingston Hospital for further assessment and scanning.


How is epididymo-orchitis treated?

  • Epididymo-orchitis is treated with a mixture of antibiotics to cover the most likely infections.
  • At the Wolverton you will usually be given:


o        CEFTRIAXONE 250mg as a single injection


o        DOXYCYCLINE 100mg capsule twice daily for 2 weeks


  • You will be advised to rest, wear a scrotal support and take regular painkillers such as ibuprofen.
  • You will be reviewed again routinely in 2 weeks after completing your antibiotics.
  • If your symptoms have not started to improve within 3 days you should attend the Wolverton again for an early review.
  • Testicular pain and swelling frequently takes many weeks or months to completely settle following treatment.


What about my partner?

  • Epididymo-orchitis is usually caused by a sexually transmitted infection so it is important that all current partners are have a full STI screen and are treated with antibiotics too.
  • Make sure that both you and your partner complete your courses of antibiotics before having sex again.
  • For men where the cause has been confirmed as a urine infection, treatment of partners is not required.


What happens if my epididymo-orchitis is left untreated?

  • The testicular pain and swelling will last much longer.
  • Untreated infection is more likely to lead to complications such as

o        chronic testicular pain

o        an abscess

o        rarely  testicular atrophy and loss of fertility


More information