In acute cases, epididymitis symptoms come on suddenly, last less than six weeks, and may only affect the epididymis. If the inflammation spreads beyond the epididymis to the testicle, the acute condition is then referred to as epididymo-orchitis. When the condition is chronic, symptoms are gradual and last longer than six weeks. Pain is located in the testicles, epididymis, or scrotum. Left untreated, epididymitis can cause scrotal abscess (when the infected tissue fills with pus), testicle shrinkage, male infertility, even necrosis (tissue death).
Treatment for both types aims to eliminate the infection and alleviate its associated symptoms.
A physician will likely prescribe medication even before making a firm diagnosis so as to clear the infection, alleviate symptoms, prevent transmission, and decrease the likelihood of future complications. Such therapies include:
- Antibiotics to kill the bacteria or prevent them from reproducing; however, these medications tend not to be effective when epididymitis is chronic because the cell wall of the bacteria often has an unusual structure and chemical composition that makes it difficult for the drugs to enter.
- Painkillers to ease discomfort
- Anti-inflammatories (such as ibuprofen and naproxen) to reduce or eliminate inflammation
Urologists tend to recommend conservative treatment, especially for those patients whose symptoms are less severe or transitory.
- Bed rest
- Scrotal elevation (placing a folded towel beneath the scrotum)
- Applying cold packs
- Wearing an athletic supporter
- Refraining from intercourse
- Local heat therapy
Surgery is rarely necessary, except in the case of an abscess or testicular necrosis. Surgery for a scrotal abscess involves draining the pocket of pus. When necrosis is involved, or when the symptoms are severe and debilitating, part or all of the epididymis may be removed (epididymectomy).
Epididymitis often improves within two to three days after taking antibiotics, and there should be no long-term impacts on sexual or reproductive abilities. Pain and discomfort may not resolve until the full course of antibiotics have been taken, and swelling and tenderness may take months to go away. But the condition can recur if the bacteria or other microbes return.
When epididymitis has become chronic, medication may need to be taken for years (or until the symptoms resolve on their own). Epididymectomies alleviate symptoms in three out of four patients, and that relief usually occurs within the first few weeks after surgery.
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Epididymitis. (2011). Oxford American Handbook of Urology.
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