Epididymitis

There are acute and chronic forms. In case of untimely treatment, orchitis may join the disease with epididymitis. With the subsequent development of epididymo-orchitis.

The causes include:

• ingress of an infectious agent from the urethra through the vas deferens. The disease can be caused by such classes of microorganisms: bacteria, viruses , fungi, sexually transmitted infections ( gonorrhea , chlamydia , gardnerella, trichomonads).
• the use of urinary catheters.
• complicated forms of urethritis and prostatitis .
• a complication arising from previous mumps (mumps).
• difficulty urinating as a cause of adenoma.
• complication of tuberculosis .

Epididymitis is often observed in men aged 15 to 30 years, and also after 60. Children rarely get sick.

• the presence of blood in semen
• painful swelling of the scrotum
• fever
• discomfort in the lower abdomen or pelvis
• inguinal pain
• soft, swollen groin areas on the affected side
• the appearance of a cyst (tumor) in the scrotum
• pain during ejaculation
• pain or burning during urination
• scrotum pain, which intensifies during bowel movements
• urethral discharge

• General blood analysis
• Ultrasound Dopplerography of the scrotum
• Scrotum scan (using nuclear medicine methods)
• Chlamydia and Gonorrhea Tests
• General urine analysis and urine culture on microflora (you may need to pass several samples, including the initial flow, the average portion, and also after prostate massage )

Prescribe antibiotic therapy. Best of all, antibiotics of the fluoroquinolone group penetrate into the tissue of the epididymis and testicle, so ciprofloxacin, moxifloxacin will be the drugs of choice. It should be noted, however, that the FDA , starting in 2016, does not recommend prescribing fluoroquinolones for the treatment of epididymitis (and a number of other diseases) due to the fact that “the risk of serious side effects associated with fluoroquinolones exceeds the potential benefit from their use [ for this group of patients] in cases where it is possible to prescribe other drugs ” ^[1] . Instead of fluoroquinolones, among others, azithromycin, doxycycline, cefixime are prescribed (depending on the pathogens detected).

Fluoroquinolones are active against chlamydia, gonococci, Escherichia coli and other pathogens that cause epididymitis (gonococci, however, are often resistant to these drugs ^[2] ). If gonococci are detected in the analyzes, ceftriaxone or cefexime is prescribed. Azithromycin and doxycycline are active against chlamydia. If Trichomonas is detected, metronidazole or tinidazole is prescribed. But it is also possible to detect trichomonads and Escherichia coli at the same time, or chlamydia and Trichomonas, therefore it is necessary to prescribe two antibiotics simultaneously.

For acute pain, NSAIDs are prescribed. In chronic epididymitis, physiotherapeutic treatment (UHF) is indicated.

Epididymitis Complications include:

• Abscess in the scrotum
• Chronic epididymitis
• Fistula on the skin of the scrotum
• Testicular tissue necrosis due to lack of blood (testicular infarction)
• Infertility due to damage to the tissue of the spermatic cord or autoimmune processes leading to the suppression of normal testicular secretion
• Scarring of the inflamed tissues of the spermatic cord makes it impossible for the sperm to mature in it, which affects the quality of sperm and, in a severe case, causes infertility (while preserving the function of the testicle, it is possible to fertilize the eggs by artificial method)
• The spread of unilateral epididymitis to the other half of the scrotum, bilateral epididymitis (much more often resulting in infertility)

Due to the anatomical difference (the appendage of the left testicle is more elongated), the left side of the scrotum is most often affected, the right side is more stable.

It is worth noting that complications are easily avoided if treatment is started without delay. It is important to pass the necessary tests before taking antibiotics, otherwise adequate treatment will be difficult to prescribe. The treatment of this disease requires monitoring by a urologist .

Important: Acute scrotum pain is a sign of urgent medical attention. In this case, an ambulance team is called or a doctor is examined immediately. It is important to consult a urologist no later than the second or third day from the onset of the first symptoms, although the disease is not severe and often does not require bed rest, because of the importance of timely treatment, it is urgent.

• You can prevent the complications of epididymitis by diagnosing the patient at an early stage.
• Prescribing antibiotics in the preoperative period
• Safe sex (having sex with only one partner at a time, using condoms) can help prevent epididymitis and sexually transmitted diseases.
• Sometimes the cause of epididymitis is sexual intercourse and masturbation that are excessively often repeated at short intervals (already the fifth or sixth ejaculation is accompanied by prolonged pain in the scrotum, the volume of the ejaculate does not exceed one or two drops). As a result of smooth muscle spasms, the spermatic cord tends to become inflamed.
• Hypothermia (local weakening of the immune system) or a general weakening of the immune system often leads to the spread of opportunistic microflora from the lower third of the urethra (the urethra inside the penis to a depth of 5-6 cm) up the ureter. As a result, inflammatory diseases arise, primarily urethritis. With untimely treatment of urethritis, the infection can spread to the bladder (cystitis), prostate gland (prostatitis), scrotum organs (epididymitis and orchitis) and sometimes to the kidneys. Normally, microflora is present only in the lower third of the urethra, the rest of the genitourinary system is sterile, so it’s important to pass the prostate secret and ejaculate on the bacterium by determining the sensitivity of the microflora to antibiotics, by the concentration (CFU / ml) and types of bacteria in the analysis, the urologist can conclude whether the patient has an infection and prescribe adequate treatment. Do not worry in advance about the microflora found in the analyzes for bacterial seeding, bacteria get into the analysis when the analysis material passes through the lower third of the urethra, from the outer surface of the penis head, hands, since the same bacteria live on the skin and are its normal microflora, and only at a concentration of about 10 ^ 5 (one hundred thousand) per ml is the disease diagnosed.