Epididymo-orchitis

Epididymo-orchitis in heterosexual men

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.

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.

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.

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.

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

FOLLOWED BY

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.

Epididymo-orchitis is usually caused by a sexually transmitted infection so it is important that all current female partners are have a full STI screen and are treated with antibiotics too.
Sometimes ex partners will need to be tested too – you will be advised about this.
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.

The testicular pain and swelling will last much longer.
Untreated infection is more likely to lead to complications such as
- chronic testicular pain
- an abscess
- rarely testicular atrophy and loss of fertility