Epididymitis: symptoms and treatment. Chronic epididymitis: how to cope with inflammation Epididymitis treatment medication

Important organs of the male reproductive system are the testicles and their appendages. Their damage due to inflammation, injury, and blood supply disorders can lead to infertility. Epididymitis is a disease associated with an inflammatory process in the epididymis.

In most men, pathology occurs due to the development of a bacterial infection in the tissues of the appendage. The main symptoms of the disease are discomfort and pain in the testicle and groin area, sometimes fever, premature ejaculation and blood in the urine. To treat the infection, it is necessary to prescribe antibacterial drugs.

What is epididymitis?

The testicles are a paired organ located in the scrotum. On the back surface of the testicle there is its appendage - a dense formation that contains a kind of tube, coiled in the form of a spiral. The tube is filled with fluid and nutrients necessary for sperm to mature. Since the epididymis is directly connected to the testicles, when they become inflamed, infection of the testicle often occurs. This disease is called epididymitis orchioepididymitis. This is the most common inflammatory process of the scrotal organs.

The end of the epididymis is connected to the vas deferens, which passes through the prostate gland to the urethra. Therefore, infection from these organs can retrogradely penetrate the appendage. Infection of the latter when microbes enter the bloodstream is rarely recorded.

Every year, one in 1,000 men develops epididymitis. The chronic form of the disease causes long-term pain in the scrotum in 80% of cases.

Causes of the disease

The causative agent of the disease is most often pathogenic bacteria that cause infectious epididymitis. They penetrate retrogradely from the tissues of the urethra, prostate, and vas deferens. This mechanism of development of pathology is observed in 80% of patients.

The main causes of epididymitis: sexually transmitted microorganisms and bacteria that are part of the intestinal microflora. In men under 40 years of age, almost 60% of cases of pathology are caused by chlamydia; gonorrhea, gardnerella, and sometimes treponema are somewhat less common.

In patients over 40 years of age, E. coli is more common. This microorganism often causes a bladder infection, and from there rises into the appendages. The risk of such an infection increases in people of any age who practice anal sex. In some cases, the disease is caused by staphylococci, streptococci and other microbes. In children and men over 40, pathology can be caused by different types of Proteus, Klebsiella, Pseudomonas, Ureaplasma, Corynebacterium and Mycoplasma. Bacteria can enter the tissue of the appendage and through blood vessels (rarely) from other organs, that is, through the hematogenous route.

In children, the cause of inflammation of the appendages can be a viral infection, including mumps, as well as infection with coxsackievirus infection, chickenpox or ECHO viruses.

In persons with immunodeficiencies, epididymitis can be caused by pathogens of coccidioidosis, blastomycosis, cytomegaloviruses, and Candida fungi.

Inflammation caused by retrograde reflux of urine from the prostatic part of the urethra through the vas deferens contributes to damage to the appendages. This happens during physical activity (for example, weightlifting) or sexual intercourse with a full bladder, and is also widespread with prostate adenoma. 56% of men over 60 years of age with epididymitis also have prostatic hyperplasia or urethral stricture.

In this case, urine is thrown into the overlying parts of the genitourinary tract, and pathogenic microorganisms penetrate with it. Therefore, it is important to empty your bladder promptly.

Acute epididymitis orchididymitis occurs in 12-19% of patients with Behçet's syndrome. In addition, the incidence of the disease increases with Henoch-Schönlein syndrome, especially in children. This is probably due to the systemic nature of the inflammatory process in these diseases. Damage to the scrotal organs is present in 38% of patients with Henoch-Schönlein syndrome.

Drug-induced epididymitis is sometimes observed, the most common cause of which is the drug Amiodarone, used for heart rhythm disorders. With this variant of the pathology, the appendages are affected on both sides. The incidence of pathology depends on the dose taken and increases if the patient uses more than 200 mg of Amiodarone per day. At the same time, the body synthesizes antibodies that are directed not only against drug molecules, but also attack the tissues of the appendage, causing lymphoid infiltration and focal tissue fibrosis.

Congestive epididymitis occurs when blood circulation in the pelvic organs is impaired. Its development is facilitated by interrupted sexual intercourse, hemorrhoids, and constant constipation. Lack of blood circulation leads to impaired nutrition of tissues and a decrease in their immune defense. Against this background, a bacterial infection quickly develops.

About 1 in 1,000 men who have a vasectomy (removal of the vas deferens) experience pain in the form of chronic, dull, aching pain in the epididymis and testicle. The pain is caused by secondary retention of sperm and seminal fluid in the epididymis, which continues to be released after the vasectomy. As a result, granulomas and inflammation of the appendage occur.

Factors that increase the likelihood of the disease are trauma and hypothermia, as well as instrumental interventions - urethral dilation, urethroscopy, bladder catheterization, cystoscopy.

In addition, the risk of the disease increases if the patient:

• does not use condoms during sexual intercourse;
• has structural abnormalities in the development of the genitourinary tract;
• suffered from or is sick with tuberculosis or sarcoidosis;
• has prostate hyperplasia or adenoma that blocks the normal flow of urine from the bladder;
• Recently had surgery on the urinary organs or groin area.

A procedure such as circumcision of the foreskin reduces the risk of developing urinary infections, and epididymitis in particular.

Sometimes the cause of acute epididymitis cannot be determined, then it is called idiopathic.

Classification

There are acute and chronic forms of the disease. These forms differ in symptoms and treatment tactics.

• Acute epididymitis

Caused by nonspecific pathogens, it develops quickly and is accompanied by the appearance of pronounced clinical symptoms, often on one side. Right-sided epididymitis usually occurs. This is due to the peculiarities of the anatomy of the male genital organs.

Often the testicular membrane is involved in the process, and dropsy occurs. With proper treatment, signs of the disease disappear after a week, but compaction in the appendage area can persist for 2 months.

The acute form is serous and purulent. In the first case, swelling and tissue infiltration are characteristic. During the purulent process, individual foci first form, and then the appendage melts on the left or right.

If treatment tactics are incorrect, the disease becomes chronic. The temperature is normal, the appendage is moderately enlarged and compacted, and minor pain in the scrotum is noted. The duration of the disease exceeds 3 months.

• Chronic forms of pathology

May be associated with inflammation, obstruction (obstruction) of the vas deferens. Sometimes there are no external changes, but prolonged pain in the affected organ persists.

There are also specific variants of pathology caused by pathogens of tuberculosis, cryptococcosis, and brucellosis. Syphilitic epididymitis is observed very rarely. Tuberculous epididymitis occurs in patients with pulmonary and other forms of tuberculosis, in particular with damage to the kidneys or bladder. Tuberculosis and other systemic diseases, for example, Behçet's syndrome, lead to rapid chronicization of the acute process.

Clinical signs

Inflammation of the epididymis occurs suddenly and often reaches its maximum severity within 24 hours. First, pain appears in the scrotum or groin. Unpleasant sensations may also occur in the lateral parts of the abdomen above the inguinal fold. This is typical for the primary focus of infection in the vas deferens. Then the microorganisms descend down, entering the appendages.

Other symptoms:

• swelling and pain in the scrotum (often the appendage doubles its normal size in a few hours);
• irradiation of pain to the lower back, groin, iliac region;
• painful urination and blood in the urine;
• mucous or purulent discharge from the urethra, especially in young men;
• redness and increased local temperature of the skin of the scrotum;
• fever and chills, nausea, weakness; the temperature may be low-grade;
• feeling of pressure or fullness in the testicles;
• enlarged lymph nodes in the groin;
• pain during sexual intercourse and ejaculation;
• pain when walking, urinating, or defecating;
• frequent urination;
• premature ejaculation;
• admixture of blood to semen.

Pain in the scrotum, urinary problems, or any of the above symptoms require a visit to the doctor. There are also situations when medical attention is required immediately.

Severe pain in the scrotum may be a sign of testicular torsion, a very serious condition that requires urgent treatment. The sooner therapy is started, the greater the likelihood of maintaining the viability of the organ.

Signs of necrotizing fasciitis or other inflammatory complications may include:

• discharge from the urethra;
• pain and burning when urinating;
• frequent urination;
• significant fever and chills;
• nausea;
• pain in the lower abdomen;
• hardening or swelling of one of the testicles.

Such signs require immediate consultation with a urologist.

Tuberculous epididymitis

Tuberculosis is a disease that can affect almost any organ, including the epididymis. Diagnosis and treatment of primary genitourinary tuberculosis is complex and requires invasive studies, including biopsy. This is necessary to distinguish tuberculous epididymitis from other diseases of the scrotum, for example, bacterial inflammation of the appendages or malignant tumors.

Mycobacterium tuberculosis enters the appendages either hematogenously or directly from the prostate gland and seminal vesicles.

Epididymitis may be a complication of treatment with the BCG vaccine for superficial bladder cancer. This occurs in 0.4% of patients treated in this way.

Isolated tuberculous epididymitis is rare and presents significant difficulties for diagnosis, since clinical manifestations and tomography data are very similar to a malignant tumor. The disease is accompanied by unilateral enlargement of the appendage, pain in the scrotum area, often there is an increase in temperature and impaired urination, for example, its frequency.

For diagnosis, urine cultures are performed, but in half of the cases mycobacteria cannot be detected in it. Ultrasound and tomography of the urinary tract are prescribed to exclude renal tuberculosis. Fine-needle aspiration biopsy and examination of the resulting material under a microscope are also used.

Tuberculous epididymitis is potentially curable with anti-TB drugs if diagnosed early. According to the recommendations of European urologists, treatment includes a combination of three anti-tuberculosis drugs for a period of 3 months, followed by two drugs for another 3 months. An alternative regimen is to use a combination of four agents for 2 months. If the disease develops against a background of suppressed immunity (for example, with HIV infection), the duration of therapy is at least 9-12 months. This treatment is prescribed by a phthisiatrician.

In advanced cases, surgery is necessary - removal of the epididymis along with the testicle. It is performed in case of ineffectiveness of medications or when complications develop, for example, abscess of the scrotal organs.

Diagnostics

The doctor collects anamnesis (medical history) and complaints, examines the patient, and performs a rectal examination of the prostate gland.

External manifestations that allow one to suspect the disease:

• a painful lump that first covers the tail of the appendage and then spreads higher;
• elevation of the affected half of the scrotum;
• normal cremasteric reflex;
• erythema of the scrotum;
• reactive hydrocele - accumulation of fluid between the membranes of the testicle;
• signs of bacterial prostatitis or vesiculitis in adult patients;
• focal compactions in the form of “beads” in tuberculous epididymitis;
• developmental anomalies of the genitourinary system (in children), for example, cryptorchidism.

Diagnosis of epididymitis includes the following additional studies:

• general urine analysis, bacteriological examination and determination of the sensitivity of the isolated microorganism to antibiotics;
• recognition of sexually transmitted diseases, first of all, using PCR - an analysis that reveals the genetic material of microbes in material - urine, blood, urethral smear;
• blood test to determine the number of leukocytes;
• immunofluorescence analysis to determine antibodies to the mumps pathogen;
• Ultrasound of the testicle and epididymis;
• Dopplerography of the scrotal organs, if necessary, to distinguish the disease from testicular torsion.

After prostate massage, a urethral swab is obtained. If gram-negative diplococci are detected in it, this confirms gonorrhea.

Computer imaging (tomography) is rarely used. It is indicated when there are difficulties in diagnosis. For example, these studies are necessary for the diagnosis of cysts, hydroceles, hernias, tumors, and abscesses.

In some cases, a cystoureterogram, retrograde urethrography, or cystoureteroscopy is prescribed.

Accurate diagnosis of the causes of the disease is very important because an incorrect diagnosis can lead to many adverse consequences. More than 50% of infectious agents that cause epididymitis are sexually transmitted. Therefore, examination and treatment of patients’ sexual partners is necessary. Some patients, such as children and older adults, have other causes, so it is important to answer all your doctor's questions openly.

Diseases with which differential diagnosis of epididymitis is carried out:

• testicular torsion;
• scrotal hernia;
• inguinal hernia;
• idiopathic swelling of the scrotum;
• hydrocele;
• pyocele (accumulation of pus between the membranes of the testicle);
• Henoch-Schönlein purpura;
• Behçet's disease;
• periarteritis nodosa;
• vasculitis;
• neuralgia or radicular pain (radiculitis);
• epididymal cyst;
• complications after vasectomy;
• spermatocele;
• testicular tumor, including hemorrhage into it;
• tumors of the testicular membranes, in particular mesothelioma;
• varicocele;
• urinary tract infections.

Treatment

In most cases, conservative methods of therapy are used. Treatment at home includes bed rest. It is necessary to use a suspensor that pulls the scrotum up. This measure can significantly reduce pain in the inflamed organ.

Spicy foods and alcohol are excluded from the diet. In the first 3 days of illness, pain can be relieved by applying cold compresses to the affected area. For pain relief, suppositories with ketorolac and drotaverine are used.

To cure epididymitis, you need to undergo a course of treatment with antibacterial drugs. Often 2 antibiotics are prescribed at once, because the pathology is caused by mixed microflora.

In men under 40 years of age, treatment is carried out according to two main schemes:

• cephalosporins intramuscularly in combination with tetracycline antibiotic tablets, course of treatment for 10 days;
• modern macrolides (for example, Sumamed) for 3-5 days.

Treatment of epididymitis in men over 40 years of age should be carried out with one of the following medications:

• Levofloxacin or Ciprofloxacin for oral administration;
• a combination of a sulfonamide agent and trimethoprim (Co-Trimoxazole) in tablets.

The doctor decides which antibiotics to treat the disease in each case. Health care workers have statistics on the sensitivity of microorganisms to different drugs in each region. Depending on local patterns of microbial resistance to drugs, the doctor may change the type of antibiotic and the duration of treatment to achieve recovery for the patient. Incorrect treatment in the early stages can lead to complications that require surgery.

In patients with non-infectious causes of the disease, anti-inflammatory drugs, such as ibuprofen, are often used. In case of a chronic process, physiotherapy is prescribed.

Absorbable drugs for epididymitis help to avoid sclerosis of the appendage tissue. These include, for example, Longidaza suppositories. They must be inserted into the rectum at night for 10-20 days. They are prescribed if, after epididymitis, the appendage is enlarged.

If, after following all the recommendations, the disease does not go away, a consultation with a urologist and additional examination is prescribed. It is important to ensure that there is no orchitis, or inflammation of the testicles. This disease not only significantly impairs a man's reproductive abilities, but can also cause the bacteria to spread through the blood to other organs. In addition, treatment failure may be due to a testicular tumor.

If sexual transmission of bacteria is confirmed, it is necessary to notify the patient’s sexual partner and prescribe him a course of treatment, even in the absence of symptoms. Otherwise, after treatment, re-infection will occur.

When an abscess forms, it is opened. If acute purulent epididymitis has developed, the epididymis along with the testicle is removed. The same operation is performed for frequent exacerbations of the chronic process. In this case, the function of the organ has already been lost, and the likelihood of infection spreading to the testicle remains.

Traditional medicine recipes

In addition to antibiotics, after consultation with a doctor, you can use folk remedies.

There are quite a few recipes for various herbal infusions. The plants that make up them have antiseptic, anti-inflammatory, soothing properties, and accelerate tissue regeneration after inflammation has ended. Here are some of them.

1. Make a collection of equal parts of juniper cones, shepherd's purse and bearberry leaves, dandelion and steelhead roots, anise and dill seeds. Place 3 tablespoons in a half-liter container. spoons of this collection, add boiling water and leave for half an hour. Then strain the resulting infusion and drink it in 2 doses throughout the day.
2. Make a collection of equal quantities of birch leaves, juniper cones, celandine leaves, steelweed roots and cinquefoil grass. Place 4 tablespoons in a liter container. spoons of the mixture and pour boiling water, let cool, then strain. Drink during the day in 3 doses.
3. Mix equal amounts of corn silk, birch buds, dry bean pods and violet flowers. Make an infusion from 1 table. spoons of the mixture and 0.5 liters of boiling water. You need to take it 2 spoons three times a day.
4. Make a mixture of equal quantities of lingonberry leaves, horsetail grass and tansy flowers. Take table 4. spoons of the collection and make an infusion in a half-liter container. Drink in 2 doses during the day.

The following components can be added to all medicinal preparations:

• peppermint;
• yarrow herb;
• calamus and licorice roots;
• wormwood grass;
• strawberry and currant leaves;
• St. John's wort, nettle;
• rosehip berries;
• Linden blossom.

Herbal infusions can be taken in a course for a month. For chronic epididymitis, if there is no need for surgery, treatment is repeated 3-4 times a year, especially in the off-season or after colds.

Complications

In most cases, acute epididymitis can be successfully treated with antibiotics. Long-term sexual or reproductive problems do not develop. However, the infection can recur, ultimately leading to the development of complications.

Bilateral epididymitis causes male infertility. The true prevalence of reproductive problems is unknown, but acute epididymitis is a rare complication. The impairment of sperm quality is transient and has the nature of secondary leukocytospermia, that is, an admixture of leukocytes or pus.

In severe cases of purulent process, right-sided or left-sided epididymitis becomes the cause of testicular abscess. An abscess that breaks out can cause the formation of a fistula.

This complication can only be treated surgically - so-called hemicastration is performed (removal of the testicle and epididymis on one side).

Impaired blood circulation in the surrounding edematous tissues can cause testicular infarction - cessation of its blood supply. As a result, organ tissues are irreversibly damaged and die.

Another complication of the disease is obstruction of the vas deferens, as a result of which sperm from one testicle do not enter the genital tract. This type of infertility develops. The incidence of this complication is unknown. Such consequences of epididymitis have an extremely adverse effect on a man’s ability to fertilize. To prevent this, it is necessary to consult a doctor in a timely manner; in case of an acute process, you can call an ambulance. Such a patient is usually sent to the hospital.

If the patient's inflammation has spread from the epididymis to the testicular tissue, the following complications may occur:

• hypogonadism, resulting from testicular atrophy and developing in 30-50% of patients;
• in 7-13% of patients; the interstitial tissue of the testis is mainly affected, rather than the Leydig or Sertoli cells, but the number, motility and morphology of sperm may change;
• constant pain in the scrotum - orchalgia.

During treatment, it is important to take the entire course of antibiotics, even if all symptoms of the disease have already disappeared. In addition, you should visit your doctor after completing therapy to make sure there are no complications.

The outcome of the disease is worse in the presence of such aggravating factors:

• diabetes;
• elderly age;
• significant increase in body temperature;
• increase in the number of leukocytes in the blood;
• an increase in the content of urea and C-reactive protein in a biochemical blood test.

Patients with epididymitis resulting from sexually transmitted diseases (chlamydia, gonorrhea and others) have a risk of contracting HIV infection, which is 5-9 times higher than that of healthy people. Therefore, all sexual partners of such patients should undergo examination and treatment.

Prevention

A measure to prevent the disease is timely diagnosis and treatment of sexually transmitted infections, including in sexual partners.

Other ways to avoid illness:

• sexual abstinence;
• using condoms, which reduces the likelihood of infection by 90%;
• sexual contact with only one partner;
• vaccination of children against mumps;
• maintaining personal hygiene.

If epididymitis is caused by long-term use of amiodarone, this drug must be replaced with another antiarrhythmic drug.

Chronic epididymitis is a common disease. According to ICD 10, it belongs to category N 45.0 “orchitis, epididymitis and epididymo-orchitis with abscess.” This disease causes inflammation of the male reproductive gland, the testicle.

The disease can occur at any age, including children. The disease negatively affects the functioning of the male reproductive system. Every man needs to know the causes of this disease, its symptoms and ways to get rid of it.

What is chronic epididymitis

With such epididymitis, a slightly pronounced inflammatory process occurs in the male epididymis. It can bother a representative of the stronger sex for a long time, sometimes more than six months. Right-sided epididymitis is possible, when the inflammatory process is localized in the right testicle and its epididymis, as well as bilateral epididymitis, affecting both testicles.

The epididymis, or epididymis, is a folded formation that is a continuation of the duct of the reproductive gland. It performs a very important function, since sperm mature in it. The epididymis is also responsible for transporting germ cells to the vas deferens. That is why diseases of this organ negatively affect the ability of men to fertilize.

Prolonged inflammation of the epididymis is characterized by the accumulation of fluid, or exudate, in its tissue. Its release occurs gradually, while the functions of the epididymis remain impaired.

Causes of chronic epididymitis

Chronic epididymitis develops primarily as a complication of an acute inflammatory process. It is also possible for this disease to develop if the acute illness was not treated properly, or when the body continues to be affected by harmful factors.

Predisposing factors for chronic epididymitis include such unfavorable conditions.

1. Sexually transmitted diseases. Particularly dangerous are cases where such diseases have not been cured.
2. Infection of the urethra.
3. Entry of a foreign body into the urethra.
4. Scrotal injuries. They can arise as a result of the characteristics of men’s professional activities. This disease can be caused by frequent microtraumas that occur while driving, running, jumping or lifting heavy objects.
5. This epididymitis can develop as a complication of the tuberculosis process.
6. Inadequate treatment of varicose veins of the spermatic cord.
7. Congestion that occurs during frequent sexual arousal without ejaculation.
8. Alcohol consumption.
9. Haemorrhoids.

Read also: Testicular hypoplasia: features of pathology, causes, treatment

Symptoms of chronic epididymitis

As a rule, chronic epididymitis is a consequence of a previous acute inflammation of the epididymis. A prolonged inflammatory process causes the formation of fibrous tissue in the appendage. It covers the appendage itself, as well as the vas deferens. Thus, the disease can cause infertility in many men due to deterioration in sperm counts.

The main symptoms of chronic epididymitis are:

1. Long duration of illness. As a rule, the disease is said to be chronic when it lasts more than six months.
2. The presence of intermittent and mild pain in the testicle. It may intensify with prolonged physical activity. If a man does not have such loads, then pain, as a rule, does not occur. During physical activity, as well as during hypothermia, pain can radiate to the lumbar region.
3. The epididymis may slightly increase in size. It can also be painful and tense.
4. With a chronic inflammatory process, the symptoms of general poisoning are not so pronounced. In rare cases, body temperature can rise to 38 degrees. Sometimes in a patient it rises to low-grade levels.
5. Chronic epididymitis can develop against the background of syphilis, gonorrhea or tuberculosis. In such cases, the likelihood of infertility is very high, since the epididymis does not perform its functions.

Chronic epididymitis does not cause acute symptoms and often patients are not aware that they have a chronic inflammatory process. This often complicates the diagnosis and treatment of inflammation of the epididymis.

Epididymitis: treatment with antibiotics, which is best at present? With untimely and incorrect observation and intervention, there is a chance of autoimmune lesions of the testicles or their atrophy.

Epididymitis is a male disease caused by inflammation, localized in the gonads (testes), and like any infectious disease, it can be corrected with drugs such as antibiotics for epididymitis.

The treatment of this disease is not so problematic, but it takes so long; in addition to the inflammation itself, it is necessary to rid the body of the infection. As soon as we eliminate the pathogenesis of this disease, the symptoms and signs will go away and the person will feel much better. For patients with uncomplicated forms of pathology, the very first and most important treatment with antibiotics for epididymitis is bed rest; it is also worth fixing the scrotum in an elevated position. To do this, you can use swimming trunks or roll a towel into a roll and thus fix the scrotum so that there is a good outflow. Drink plenty of water, adhere to a strict diet with the exception of spicy, salty, smoked, fried foods. Nutrition has a special influence on metabolic processes. You can also recommend a cold compress or ice to relieve pain. Cold helps reduce pain and swelling; apply it for no more than two hours, but at the same time take breaks, in order to also avoid colds. Also, if the pain does not stop, you can resort to novocaine blockades, it will relieve the pain symptom. Treatment consists not only of local treatment, but is also complex; the primary cause of the disease must be taken into account, because as we know independently, it is extremely rare. It is necessary to start with conservative treatment of epididymitis with antibiotics and start from the very beginning. The drugs are prescribed in combination with analgesics, antispasmodics, vitamins, and immunomodulators. Urologists begin with mass antibacterial therapy not with one, but with several groups of drugs at once; its choice depends on the flora and type of bacteria and routes of infection.

It is worth considering the severity of the course and the severity of the phase, whether it is acute, chronic, or recurrent. Antibiotics for the treatment of epididymitis in men begin to be taken from the first day of inflammation, and the course lasts up to several weeks, and in severe cases, months. There are three ways to administer antibiotics to the affected body: intravenous (the most effective since the active substance enters the bloodstream and is quickly delivered to the affected organ), intramuscular (less effective, but also an acceptable route), and of course the painless and easy route of delivery of the active substance, In which you can be treated on an outpatient basis, this is a tablet form of administration. Antibiotics come in tablets, capsules, and powders. It is worth paying attention to the digestibility of the drug and the resistance of the microorganism to the various active ingredients in the drug. We will try to answer current and frequently asked questions, what antibiotics for epididymitis? Broad-spectrum antibiotics - they act not on one group of microorganisms, but can affect several at the same time. Epididymitis, which antibiotics are better? Fluoroquinolones are considered the most used, although they have a sufficient number of side effects, but they also act quickly and efficiently. It is worth noting that this group of drugs is rarely used for children, only for health reasons. Epididymitis in men, antibiotics are exclusively selected according to flora and active substance.

If the patient is under 35 years of age, then it is best to prescribe drugs from the macrolide group (Azithromycin), tetracyclines (Doxycycline), and fluoroquinolones (Levofloxacin or Ofloxacin). Epididymitis can be treated with antibiotics for a long time; it can last up to twenty-one days. If we assume that the patient has sexually transmitted diseases, then Ceftriaxone would be the ideal option.

If a patient is over 35 years old, in whose body, as a result of urine tests, bacteria are present and there are manifestations of damage to the urinary tract, or an anomaly is diagnosed, such patients are recommended to take trimoxazole by mouth. In more difficult cases, beta-lactam drugs in combination with sulfonamides are recommended. They cope well with gram-positive and gram-negative forms. When taking antibiotics, doctors often prescribe painkillers, antipyretics, and anti-inflammatory drugs (Indomethacin, Celebrex, Diclofenac, Efferalgan), but to reduce swelling, pain, and relieve inflammation, Doxycycline is used more often, up to twice a day. But if the antibiotic still did not help or the patient turned to the doctor late for help and the appendage still festered, then there is another radical treatment, with aggravating consequences.

If the appendage has become suppurated, then radical methods of resection of the appendage are started. But such operations more often occur in men over 50 years of age, since surgical treatment of the epididymis will lead to infertility. Treatment can also be supplemented with folk recipes; they will help relieve heaviness and pain. Infusions of herbs and decoctions of mint, black currant, St. John's wort, rose hips, lingonberries, nettle, anise, parsley, dandelion will relieve swelling, remove inflammation, redness and relieve intoxication.

Levofloxacin for epididymitis

Levofloxacin for epididymitis is, of course, a broad-spectrum antibiotic. The drug acts on a wide range of pathogenic forms that cause inflammation. Levofloxacin is a bactericidal drug and is used in tablets, but there is also a drug for infusion. The drug destroys pathogenic organisms, acting on them at any level. But if we consider bacteriostatic antibiotics, they can only stop reproduction, affecting only cell division. That is why it is one of the strongest antibiotics for the treatment of epididymitis, which can destroy growing and dividing cells in the early stages. Belongs to the group of fluoroquinolones.

As we have already said, this group is prescribed to children with caution and only for health reasons. There are also analogues of this drug, such as Ciprofloxacin, Levofloxacin, Ofloxacin for epididymitis, one of the analogues that most often replaces levofloxacin. All these drugs disrupt the synthesis and act on genetic information, and prevent it from multiplying, and due to the accumulation of the drug, it destroys it. The drug is used at a dose of 500 mg (1 tablet) per day for up to 14 days. You should not stop taking the drug suddenly or skip doses, because the drug accumulates in the body. Side effects may occur:

• headache;
• dizziness;
• loss of consciousness;
• nausea;

The drug can be combined with other drugs only very carefully!

Azithromycin for epididymitis, dosage

This drug from the group of macrolides has a wide spectrum of action and is classified as bactericidal. A very popular drug among adults, you can hear many positive reviews about it confirming its effectiveness. A little history - this is the first drug from the group of macrolides and it was called Azalide. The drug acts exclusively on gram-positive bacteria. A derivative analogue of erythromycin, but has fewer side effects and has a fairly positive effect on the gastrointestinal tract. The drug inhibits the production of protein in microbial bodies, inhibits and inhibits the proliferation of microbes. It is prescribed to adults and children over 12 years of age, 1 dose per day, 1 hour before meals or 2 hours later. Headache, dizziness, numbness of the limbs, increased excitability, anxiety, tachycardia - these are the side effects that Azithromycin causes. Epididymitis is well corrected with this drug in young men. Today you can choose an analogue of this drug - this is Sumamed, it is identical in its composition, only the price is much higher. A contraindication for this drug is hypersensitivity to macrolides; it should also not be used if you have liver or kidney diseases, as it can negatively affect the functioning of these organs. It is also better not to administer to children under 12 years of age. Interacts with other drugs.

Amoxicillin for epididymitis

Amoxicillin for epididymitis is a penicillin antibiotic. The semi-synthetic drug is used for inflammatory reactions and has a bactericidal effect on gram-positive microorganisms. An analogue is ampicillin; when administered orally, it is highly absorbed in the body. And if the drug is combined, it will be many times more active; more often it is combined with metronidazole (an antifungal) drug. The drug quickly penetrates into cells from the stomach without being destroyed in its acidic environment. The drug is ideal for children and penetrates the blood-brain barrier quite well, spreading widely into the tissue. It is necessary to dose with caution, because it has a number of features. For epididymitis, amoxicillin is used in a dose of 250-500 mg for adults, for children up to 200 mg. Causes adverse reactions: allergic, rheumatic, ataxia, depression. With prolonged use, superinfection may occur. When used simultaneously with digoxin, its bioavailability increases, the prothrombin index decreases, the concentration of vitamin K decreases, and toxicity increases. The antibiotic accumulates and its concentration remains for up to five days and you should not use drugs that are incompatible with this antibiotic during these days.

Unidoxsalutab for epididymitis

Unidoxsalutab for epididymitis is a drug of semi-synthetic origin. It has a wide spectrum of action and can be classified as a new generation of tetracyclines. This drug is bacteriostatic due to the suppression of protein synthesis in the microorganism. Trade name Doxycycline. The drug penetrates well through the wall of the stomach, its concentration appears within an hour, and after three hours the maximum concentration is reached. The drug penetrates the blood-brain barrier, through the placenta to the fetus, and can also accumulate in breast milk. The drug accumulates well in the prostate gland and testicles in high concentrations. Epididymitis is treated with unidoxalutab at a dosage of 200 mg per day for at least four weeks. But it’s worth pointing out that iron neutralizes the drug and disrupts its absorption abilities. The drug is taken before meals and washed down with plenty of water, so as not to injure the mucous membrane of the esophagus and stomach, it is necessary to maintain an equal period of time. It is worth remembering that the drug is not prescribed with penicillin-type drugs, as well as with cephalosporins and a number of other antimicrobial drugs that have a bactericidal effect; they will inhibit each other.

Treatment of epididymitis in men with amoxiclav

A combination drug of the penicillin series, the active ingredient is amoxicillin. It has a wide spectrum of action, and the drug also consists of clavulanic acid. The drug is available in the form of tablets, powders, and soluble powder for injection. The drug destroys it by reducing beta-lactamase in the microbe. But it is sensitive to amoxiclav and gram-negative microorganisms. It is well absorbed into the body, the drug accumulates within the first hour after use. The drug is dosed in tablets every 8 hours around the clock; the course of taking the antibiotic should be at least 10 days. The drug is not prescribed for liver or kidney disease; it causes allergies when combined with a cephalosporin. The drug is easy to tolerate; side effects are more common in older people or in people who take it for a long time. Nausea, vomiting, stomatitis, gastritis, enterocolitis, hepatitis, anemia, leukocytosis, headache, confusion, insomnia, convulsions, liver enlargement, erythema, urticaria, dermatitis, candidal infection may occur. The drugs should not be taken with other antibiotics. It is also worth remembering that the drug should not be taken with hormonal contraceptives. But it is worth taking it under the guise of probiotics Linex, Acipol, and others. Treatment of epididymitis with amoxiclav is effective; it is one of the drugs of choice.

Ceftriaxone for epididymitis, treatment doses

Broad-spectrum antibiotic, cephalosporin series, third generation. The good thing about it is that it is injectable. But the drug is diluted with lipocaine, or novocaine in some cases, if an allergic reaction is observed, it must be diluted with saline solution. The drug blocks the production of murein and destroys the cell wall of the microbe and the death of the microorganism. The antibiotic acts on many organisms, but many are resistant to it; it is worth doing a sensitivity test before use. Bioavailability is 100%; after injection, the drug is detected in the blood within 2 hours. The drug is easy to tolerate and has minimal symptoms, but there are a number of people for whom it is not suitable, who are intolerant to penicillins and carbopinems, and can provoke anaphylactic shock. Epididymitis is treated with ceftriaxone, the dose is 1 gram per day or 0.5 grams every 12 hours for 10-14 days.

When taking this antibiotic, drinking alcohol is strictly prohibited; it can cause a number of side effects: headache, bitterness in the mouth, itchy skin, erythema, diarrhea, chills, agitation. It also promotes the formation of kidney stones. The drug should be covered with probiotics.

Doxycycline for the treatment of epididymitis

A broad-spectrum tetracycline antibiotic has a bacteriostatic effect; the drug inhibits the proliferation of the microorganism. It affects the development of oxygen and oxygen-free microorganisms. The drug is not effective against fungi and viruses. The tablets are taken internally and are well absorbed in the stomach without damaging the stomach wall. It is enough to take the drug once a day, the effect of accumulation of concentration is maintained. The drug binds to urine and feces and is excreted from the body. The drug slows down mental and mental activity. Many doctors claim that this is an ideal drug for affecting any organism, but do not forget about the sensitivity and severity of the course, and concomitant pathologies. The drug is taken with caution and under the supervision of the attending physician. There will be dysbiosis and probiotic preparations will help you correct it. Doxycycline for epididymitis is prescribed at a dose of 200 mg per day, which can be divided into 2 doses; if symptoms are reduced, reduce the dose to 100-150 mg per day for 10-14 days.

Ciprofloxacin for epididymitis

Ciprofloxacin for epididymitis is an antimicrobial antibiotic with a broad spectrum of action and is part of the fluoroquinalone group. One of the most effective and high-quality drugs. It has a bactericidal effect on the DNA enzyme and destroys it. This drug has a greater effect on gram-negative aerobes. Sufficiently, abundantly absorbed in the small intestine. If you drink the drug before meals, it will significantly slow it down, but it will not affect the bioavailability. The drug can be taken by pregnant women at any stage, during lactation, and by children under 18 years of age; modern medicine has proven that there are no side effects if dosed correctly.

Remember that the tablet is taken on an empty stomach and in the dose prescribed by the attending physician. The disease epididymitis and ciprofloxacin are on the same level, and this drug is prescribed for inflammation of the urinary system at a dose of 250-500 mg per day in 2 doses, it all depends on the severity of the disease. The duration of treatment can be from 7-10 days.

Epididymitis is inflammation of the epididymis. For obvious reasons, this disease develops only in men.

Epididymitis is almost always acute, although sometimes it is chronic. Most often it is unilateral (right-sided or left-sided). Less commonly, bilateral epididymitis occurs. Very often the testicle is involved in the pathological process. In this case, epididymitis orchioepididymitis is diagnosed. Most often, the appendage is primarily affected. Because when infection spreads from the urethra, it is closer to the source of inflammation. Only after inflammation of the epididymis is the testicle affected. But there are also opposite situations.

Primary testicular damage is possible when the infection spreads from another source in the body through the hematogenous route. That is, viruses or bacteria enter the testicle through the blood. And from there they penetrate into the appendage. An example of such a spread of infection is mumps.

The virus initially affects the salivary glands. But it can spread to other organs, including the testicles, and from there to the epididymis.

An infectious process can occur when a bacterial infection spreads from the structures of the respiratory system. Sometimes it occurs as a complication of influenza, pneumonia or tonsillitis.

1. Sexual infection.

Most pathogens primarily affect the urethra. But in the future, the infection can spread upward to other organs.

The risk increases with:

• long course of the disease;
• lack of adequate treatment;
• weak immunity;
• the presence of several pathogens of sexually transmitted infections simultaneously.

2. Systemic infectious diseases.

A number of specific infectious diseases can lead to inflammation of the appendage. These include tuberculosis, syphilis, cryptococcosis, and brucellosis. In this case, the infection spreads to the epididymis through the circulatory system.

3. Medical procedures.

Infection can enter from the lower genitourinary tract during various procedures and operations.

Epididymitis can occur due to bougienage of the urethra (its expansion in the event of strictures). Diagnosis using cystoscopy also increases the risk of spreading the infection.

The risk of epididymitis increases with bladder catheterization. And the longer the catheter is in the urethra, the more the likelihood of infectious complications increases.

4. Trauma.

Due to injury or bruise of the scrotal organs, inflammation in the epididymis may develop. This option is called post-traumatic. It accounts for about 10% of cases in the structure of this pathology.

It is often not possible to find out the etiology of the inflammatory process of the epididymis. Usually the outcome of the disease is complete recovery. But in 15% of cases the disease becomes chronic. Even if the symptoms subside, further exacerbations are possible.

Patients often ask whether it is possible to have sex with epididymitis. This is problematic, given that the disease is accompanied by severe pain. Yes, and it is undesirable, because sexual intercourse contributes to the spread of infection in the body. And if epididymitis is caused by sexually transmitted infections, then the patient can infect his partner.

Epididymitis: symptoms

With acute inflammation on the left or right, the epididymis increases in size and becomes dense. Normally it is smaller than a testicle. But with the development of epididymitis, it exceeds it in size. An inflammatory infiltrate appears.

Arteries and lymphatic vessels are compressed. Exudate accumulates in the epididymis. It can be mucopurulent or purulent. The tubules of the epididymis expand. Often the vas deferens on the affected side becomes inflamed at the same time. Its opening is narrowing. Exudate accumulates inside. Often the membranes of the spermatic cord also become inflamed. This condition is called funiculitis.

The first signs of inflammation of the appendage appear acutely.

Usually the cause of pathology in young men is infection from a partner. After a few days or weeks, your body temperature suddenly rises. Although the disease can occur in the absence of fever. The epididymis is sharply painful. The pain increases with palpation. There is swelling and tenderness of the spermatic cord.

As a rule, epididymitis is combined with urethritis. Because the infection primarily affects the urethra, and only after that it spreads to the epididymis. Therefore, upon examination, a man may experience discharge from the urethra. They are detected if there has been no urination in the last 2-3 hours. Otherwise, secretions, bacteria and white blood cells are washed away in the urine. Often the swelling also affects the membranes of the testicle. The skin of the scrotum loses its folded structure. The scrotum swells and increases in size. The skin often turns red. Sometimes reactive dropsy of the testicular membranes appears. This is a condition in which clear fluid accumulates between the membranes. This type of dropsy is symptomatic.

It disappears after the underlying pathology is cured. The mechanism of its appearance is due to deterioration of blood circulation and congestion. With the development of dropsy, difficulty urinating may occur. Coitus is impossible. The skin of the scrotum is easily folded. The testicle is inaccessible for palpation. Epididymitis often causes severe pain.

They give to:

• sacrum;
• lumbar region;

Often the pain increases sharply when trying to move. Therefore, the man is forced to remain in bed. This allows him to reduce pain.

In its acute form, the disease usually lasts no more than 1 week. Then the symptoms begin to decrease. Body temperature decreases, swelling of the scrotum goes away. At the same time, the appendage remains increased in size. It feels dense to the touch.

Palpation may be painful for the patient. Subacute epididymitis may last several weeks. To select an effective treatment regimen, it is important not only to establish the fact of inflammation of the epididymis. It is also necessary to clarify which pathogen caused the pathology.

All patients are prescribed a microscopic examination of discharge from the urethra. The doctor can detect diplococci in it. Their presence indicates a gonococcal infection (gonorrhea).

The absence of diplococci against the background of elevated leukocytes indicates non-gonococcal urethritis. If a pathology caused by the mumps virus is suspected, a blood test is performed for antibodies. Infection is indicated by an increase in the level of immunoglobulin M.

The main diseases for which differential diagnosis is carried out:

• spermatic cord cyst;
• strangulated inguinal hernia;
• varicocele grade 3;
• oncological formations.

Questioning the patient helps in diagnosis. Epididymitis is indicated by a history of urethritis. Prehn's symptom helps to distinguish the inflammatory process from torsion. Elevating the scrotum may make the pain worse or worse. If it weakens, this speaks in favor of torsion.

Blood access to the organ is restored, so pain decreases. If the pain intensifies, most likely it is an inflammatory pathology.

Epididymitis: treatment

Treatment may vary depending on the causative agent of the infection.

Different bacteria are sensitive to different drugs. But drugs are chosen not only based on the pathogen. The ability of the drug to accumulate in the tissues of the testicle and epididymis is also taken into account.

The scrotal organs are separated from the rest of the body by the blood-testis barrier. Some drugs do not penetrate through it well. Therefore, they may not provide the desired effect even if bacteria are highly sensitive to them.

Currently, the following groups of antibiotics are considered the most preferable:

• fluoroquinolones (levofloxacin);
• cephalosporins (ceftriaxone);
• macrolides (azithromycin).

Studies show that these antibiotics penetrate the blood-testis barrier better than others.

It is not always possible to find out exactly which pathogen caused the pathology. The pathogen can be accurately determined if the disease develops against the background of urethritis. In this case, you should first think about sexually transmitted infections.

Arguments in favor of this version may also be:

• young age of the man;
• high sexual activity;
• recent change of partner.

A swab is taken from the urethra. It can be tested by PCR for infections.

If necessary, tank seeding is also carried out. Ejaculate can also be examined. In addition, empirical research may be conducted before research results are available.

In young men, chlamydia trachomatis remains the most common pathogen causing epididymitis. This infection is usually treated with doxycycline. But since it does not penetrate the blood-testis barrier well enough, preference is given to macrolides. Josamycin (Vilprafen) or azithromycin (Sumamed) is prescribed.

At the same time, older men often experience epididymitis due to stagnation of urine.

Pathogens spread from the bladder. In them, the disease can be caused by uropathogens. In this case, it is possible to prescribe fluoroquinolones or fosfomycin.

Antibiotics are the mainstay of therapy. But other drugs are also prescribed. They are used for symptomatic and pathogenetic treatment.

Medicines used:

• absorbable;
• enzymes (to increase the effectiveness of antibiotics);
• painkillers;
• anti-inflammatory and antipyretic drugs.

To reduce pain, cold is often applied to the scrotum. But its impact should not be excessive. Applying ice can cause frostbite. Also, for severe pain, novocaine blockades of the spermatic cord are used.

Antibiotics are also added to the solution. Therefore, this method of treatment helps not only to reduce pain for a long time, but also to quickly destroy pathogenic microorganisms.

During the recovery period, physiotherapy can be used to quickly eliminate infiltrates.

Absorbable drugs are prescribed. Instead of cold, which was used to reduce pain, heat is now used. The disease may become chronic. In this case, the treatment will take longer. A tank culture of the ejaculate and determination of sensitivity to antibiotics is required. After this, drugs are prescribed to which the microorganism is most sensitive. After the course of treatment, monitoring is carried out. To do this, the man takes tests again.

In severe cases, suppuration of the epididymis with tissue necrosis occurs. In this case, surgical treatment may be required. The epididymis is removed, sometimes along with the testicle. This is necessary if there is a threat of further spread of infection with generalization of the pathological process.

Some people try to be treated with folk remedies at home. They use herbs or propolis for this. A very common method is to use a compress with propolis tincture. It is applied to the scrotum. It is believed that after this the inflammation should go away. But in reality this does not happen. The use of folk remedies does not cure orchitis. Sometimes the inflammatory process actually subsides.

Symptoms of epididymitis may improve. But this does not mean recovery. If the pathology is caused by a sexually transmitted infection, then it is impossible to destroy it with traditional treatment. Only antibiotics can cope with this task. The dosage and regimen should be selected by the doctor, based on the severity of the pathology and the isolated pathogen.

Self-medication, especially using folk remedies, leads to adverse consequences.

They are as follows:

• the disease can become chronic;
• complications are possible: abscesses, infertility, generalization of the infectious process with damage to internal organs;
• If you have a sexually transmitted infection, you will infect other people.

Treatment should only take place under the supervision of a doctor, sometimes in a hospital setting.

Consequences

If epididymitis does not go away for a long time, it is fraught with complications. Infertility often develops against the background of this disease. It may be due to two reasons. As a result of epididymitis, both secretory and obstructive infertility can develop.

Obstructive infertility is caused by impaired sperm excretion. That is, sperm are formed, but they cannot penetrate into the external environment during sexual intercourse. This is due to the fact that the vas deferens are blocked. In case of inflammation of the epididymis, their lumen always narrows.

And with a prolonged course of the inflammatory process, fusion of the walls is possible. But infertility develops only when the process is bilateral. Because with unilateral epididymitis and obstruction of the vas deferens, sperm will still enter the urethra in a certain amount. They will get there from another testicle. Therefore, a man's fertility may be reduced. But conception is still possible.

It may just take longer for pregnancy to occur due to a decrease in the number of sperm in the ejaculate.

Epididymitis is often accompanied by orchitis. When the testicle becomes inflamed, the pathology can become chronic. In this case, organ atrophy is observed. It occurs due to swelling and poor circulation.

Testicular atrophy carries the risk of impaired spermatogenesis. This type of infertility is called secretory. Because it is associated with impaired sperm production.

Like obstructive infertility, secretory infertility develops in the case of an inflammatory process that is bilateral in nature.

And with unilateral orchiepididymitis, subfertility may occur.

If you experience signs of epididymitis, contact our clinic. Experienced urologists work here who will quickly make a diagnosis and prescribe the necessary treatment. We can provide you with a full diagnostic test.

Modern tests will help establish the cause of the pathological process and identify the causative agent of the infection. After this, you will be prescribed treatment. It will destroy the causative agent of epididymitis and eliminate the inflammatory process.

Epididymitis is inflammation of the spiral tube (epididymis) at the back of the testicle. The disease is most often caused by a bacterial infection, including sexually transmitted infections. Chronic epididymitis is quite rare, but has more serious consequences than the acute form of this pathology. Fortunately, the disease is successfully treated.

What is chronic epididymitis

Epididymitis is inflammation of the epididymis. It is located on the testis (testicle) itself and can be felt as a small ridge (spiral tube) on the back of it. The epididymis of the testis is normally softer than the testicle itself and does not exceed 1/2–1/3 of its size in length. With this disease, swelling may be observed in the area of ​​inflammation of the scrotum.

In men, the testicles are the gonads - a paired organ that is located in the scrotum and produces sperm and testosterone.

The male reproductive system is a set of organs with reproductive function, an important part of which is the testicle and its appendage

The disease affects men of all ages, but it most often occurs between the ages of 14 and 35 years.

Epididymitis that lasts longer than six weeks or recurs (recurs) is considered chronic. Its symptoms increase gradually, and the cause is often difficult to identify. At the same time, the testicle itself can become inflamed (this disease is called orchitis). This is why the term epididymo-orchitis is commonly used.

Inflammation from the epididymis often spreads to the testicle

Due to the anatomical features of the structure of the genitourinary system, left-sided epididymitis most often occurs in men. Cases of bilateral and right-sided inflammation are much less common. Unfortunately, the chronic form of the pathology most often affects the appendages of both testes. It is bilateral chronic epididymitis that can cause infertility in a man, since as a result of long-term inflammation, adhesions can form inside the epididymis, complicating or blocking the passage of sperm.

Causes

The most common cause of chronic epididymitis is sexually transmitted infections (STIs), especially gonorrhea and chlamydia.

• But the disease can also be caused by other factors, for example:
• urinary tract infections (UTI);
• infectious inflammation of the prostate gland;
• undergone medical procedures in the scrotum area;

injuries to the testicles and scrotum.

According to the Centers for Disease Control and Prevention (CDC) in the United States, gonorrhea and chlamydia are the most common causes of epididymitis in men aged 35 years or younger.

Provoking factors

• A man may be at increased risk of developing epididymitis if he:

  Not circumcised. A number of scientists believe that the foreskin in men is susceptible to frequent microtraumas (wounds), which pose a risk of contracting various bacterial and viral infections. In this sense, circumcised men (and these are traditionally Jews and Muslims) are more protected from infection entering the genitourinary tract.

• One of the advantages of circumcision in men is considered to be a lower risk of infection compared to the presence of a foreskin.
• Has structural changes in the urinary tract.
• Has an enlarged prostate, which puts pressure on the bladder and increases the risk of developing infections due to chronic stagnation of urine.
• Uses a urinary catheter. A urinary catheter, like surgical procedures, carries an increased risk of developing a bacterial infection.
• He takes a heart drug called Amiodarone.

  One of the rare side effects of Amiodarone is inflammation of the epididymis.

Pediatric epididymitis

Children get epididymitis just like adults, although the inflammation is likely to have a different cause. Common causes of inflammation of the appendages in children include:

• direct trauma;
• UTIs that extend to the urethra and epididymis;
• reflux (reflux) of urine into the appendages;
• twisting or kinking of the epididymis.

Symptoms

Epididymitis may begin with a few minor symptoms. But if they are not responded to in time, the condition usually worsens. Chronic epididymitis is accompanied by a long (more than 6 weeks) history of pain, which intensifies and subsides, but does not disappear completely.

Patients with chronic epididymitis may notice:

• low-grade fever;
• pain in the pelvic area (lower back);
• a feeling of pressure or fullness in the testicles;
• soreness and sensitivity of the testicles;
• redness and warmth in the scrotum (usually unilateral);
• enlarged lymph nodes in the groin;
• pain during sexual intercourse and ejaculation;
• pain during urination or defecation;
• urgent and frequent urination;
• abnormal discharge from the penis;
• blood in sperm.

With a long-term chronic course of epididymitis, the scrotum can thicken and become insensitive, while external signs of swelling do not always appear, unlike the acute form.

Chronic epididymitis refers to inflammation characterized by persistent testicular pain in the absence of scrotal swelling.

Typical symptoms of epididymitis in children include:

• discharge from the urethra;
• discomfort in the pelvis or lower abdomen;
• pain or burning during urination;
• redness or tenderness of the scrotum (usually unilateral);
• elevated temperature.

You should consult a doctor immediately if you have discharge from the penis or pain during urination.

Diagnosis of epididymitis

Epididymitis is diagnosed by a urologist or andrologist. First, the doctor performs a physical examination of the patient, paying attention to:

• appearance of the scrotum;
• presence of swelling or redness;
• enlarged lymph nodes in the groin area.

The urologist will ask in detail about the symptoms and the time of their occurrence, clarify information about the presence of discharge from the urethra, and if the answer is positive, take a sample for bacteriological analysis for STIs. Such a study is necessary to determine the pathogen and its sensitivity to antibiotics for further treatment.

Differentiation of pathology

Some facts are important for the differential diagnosis of the disease, for example:

• gradual onset of scrotal pain and swelling, usually unilateral, often developing over several days or weeks (as opposed to hours, which is typical for spermatic cord torsion);
• high temperature and chills (in 25% of adults and 71% of children) - indicate an acute form of inflammation of the appendages;
• Epididymitis usually does not have symptoms such as nausea or vomiting (unlike testicular torsion).

Photo gallery: testicular diseases that require differentiation in epididymitis

Varicocele - pathological dilatation of the veins of the spermatic cord Hydrocele - hydrocele of the testicle, accumulation of fluid between its own membranes Orchitis - inflammation of the testicle Testicular cancer is a malignant tumor that begins to develop directly in the testis Spermatocele - cyst of the epididymis containing spermatozoa

Laboratory diagnostics

Although epididymitis is usually associated with an infectious process, identifying the specific pathogen based on external signs is difficult. The patient will need to undergo the following tests if epididymitis is suspected:

• a general blood test will show whether there is inflammation in the body (with epididymitis, the level of leukocytes and the erythrocyte sedimentation rate increase);
• general urinalysis - reveals the presence of bacteriuria (but bacteria are found in the urine only in 50% of patients) or pyuria (pus in the urine);
• bacterial culture of urine sediment - the procedure involves submitting urine to place it on a nutrient medium in order to obtain the growth of colonies and their further identification; the analysis is necessary to check for the presence of a urinary tract infection or STI.

If a sexually transmitted disease is confirmed as the cause of epididymitis, the doctor gives an additional referral for tests for HIV and syphilis.

Instrumental techniques

It happens that for differential diagnosis (primarily, differences from spermatic cord torsion), it is necessary to use other imaging research methods:

Treatment

Treatment of epididymitis involves treating the underlying infection and reducing symptoms. In case of chronic recurrent course of the disease, bed rest is indicated during exacerbations. Treatment is usually successful, but long-term. Sometimes it may take several weeks for the soreness or discomfort to completely disappear. Most cases of epididymitis are completely cured within 3 months.

According to research results, the most common medical treatments for chronic epididymitis are antibiotics and anti-inflammatory drugs.

Drug therapy

Pharmacological treatment consists of drugs from the following groups:

1. Antibiotics (Doxycycline, Ciprofloxacin and others depending on the pathogen). Taking medications from this group is indicated for 4–6 weeks for chronic epididymitis. When treating epididymitis caused by chlamydia and gonococcus, it is also necessary to simultaneously treat the sexual partner for these infections.
2. Analgesics. They have an analgesic effect. The group includes drugs available over the counter (Ibuprofen) as well as prescription drugs (Codeine or Morphine).
3. Anti-inflammatory drugs (Piroxicam, Ketorolac). Reduce swelling and other inflammatory phenomena.

Photo gallery: medications for the treatment of epididymitis

Doxycycline is a broad-spectrum antibiotic prescribed immediately after diagnosis Ibuprofen has analgesic and antipyretic effects Piroxicam is a non-steroidal anti-inflammatory drug that helps overcome the symptoms of epididymitis.

Surgery

In some cases, invasive treatment may be required.

One of the serious complications of epididymitis is an intrascrotal abscess (an accumulation of pus), which must be opened and drained surgically.

1. The patient is urgently hospitalized in the urology department for surgery. The intervention is performed under local anesthesia through open access:
2. Opening all the cavities of the abscess with a longitudinal incision, the surgeon empties them and washes them with an antiseptic.
3. The wound is packed to separate the abscess from the surrounding tissues. Since the body perceives the tampon as a foreign body, it begins to produce fibrin on the surfaces of the tissues that come into contact with it. Then the formation of young connective tissue occurs.
4. The tampon is removed after 7–8 days, when the body begins to reject it on its own.
5. The wound is stitched up.
6. After surgery, antibiotic therapy is administered.

A scrotal abscess that is operated on in a timely manner usually ends favorably

In the long term, complications may arise in the form of:

• dysfunction of the testicle and its epididymis;
• loss of patency of the vas deferens;
• insufficiency of male sex hormones;
• infertility.

In case of necrosis of epididymal tissue, an epididymectomy (removal of the epididymis) is performed, and if the destructive process has affected the testicle itself, then a decision is made to perform orchiectomy (amputation) of one testicle, especially if the second remains healthy.

A dangerous rare complication of an abscess is rapid necrosis of the scrotal tissue - Fournier's gangrene. The negative scenario in the form of death in the case of gangrene reaches 80%.

Surgery may also be required to correct any physical defects (such as urinary tract obstruction) that may be causing epididymitis.

During the treatment of chronic epididymitis, doctors recommend:

In cases of STIs, the patient and his sexual partner should abstain from sexual intercourse for a week after finishing the course of antibiotics and confirming recovery.

Treatment of pediatric epididymitis

Treatment for pediatric epididymitis will depend on the underlying cause of the condition. In most cases, the condition can resolve on its own with rest and painkillers such as Ibuprofen. If a bacterial infection similar to that coming from a UTI is confirmed, antibiotics are prescribed. Children are also advised to drink more water and avoid the urge to urinate for a long time.

Folk remedies

There are many plants that are useful in the treatment of epididymitis, they have a natural antibacterial effect and are also a natural pain reliever:

1. Horsetail tea. This herb has numerous antibacterial properties that prevent further spread of the disease. Herbal tea must be taken once a day to get a noticeable effect. To brew a medicinal drink, take 2 teaspoons of herbs per 250 ml of boiling water.
2. Cranberry juice. The combination of acids (malic, citric, benzoic) in this berry can kill bacteria that cause infection. Preparation and use:
   • mash 0.5 kg of berries, pour the resulting juice into a separate bowl, after straining it;
   • pour 1.5–2 liters of boiling water over the cake;
   • bring to a boil, stir and leave to brew for 30 minutes;
   • strain, add drained cranberry juice;
   • drink 2-3 glasses a day, maybe with the addition of honey.
3. Raw garlic. For a natural antibiotic effect, you can use a few cloves of raw garlic to season your dinners. It is advisable to crush them before use, since this releases allicin, an organic compound that has a bactericidal effect.
4. Oregano (oregano). This natural medicine is rich in essential oil with a high content of carvacrol. Such oils are superior in their bactericidal properties to many existing antibiotics. To obtain the desired effect, it is enough to add oregano daily as a seasoning to various meat and mushroom dishes, sauces, and gravies.

Photo gallery: components of folk remedies for epididymitis

Horsetail tea for epididymitis is drunk once a day The combination of natural acids in cranberry juice has an antimicrobial effect Oregano (oregano) essential oil contains the substance carvacrol, which slows down the growth of certain bacteria. Garlic has natural antimicrobial properties

Physiotherapy

Physiotherapy methods are used as auxiliary methods outside the period of exacerbations. These include:

• UHF therapy - treatment with a high-frequency electromagnetic field (oscillation frequency 40.68 MHz or 27.12 MHz);
• diathermy - deep heating of tissues with high-frequency currents (electrotherapy method);
• mud therapy.

Dietary nutrition for chronic epididymitis

A beneficial diet for treating epididymitis includes consuming foods that can reduce inflammation.

• Foods that may be helpful in reducing inflammation include:
• spinach;
• blueberries;

strawberries
Since patients with chronic epididymitis usually suffer from urinary problems, they need to eat foods such as celery and parsley that relieve these symptoms.

Typically, epididymitis is caused by a bacterial infection. To treat the cause, patients should eat more fresh vegetables and fruits rich in vitamin C. This is beneficial for boosting immunity. Foods rich in vitamin C include:

Foods high in vitamin C increase the body's anti-inflammatory function

Consequences and prognosis Most cases of epididymitis are successfully treated with antibiotics. But chronic epididymitis is more difficult to overcome than acute epididymitis, and the pain associated with it lasts longer.

In most cases, there are no long-term sexual or reproductive problems. But the infection may recur in the future.

• Complications are rare and may include:
• fistulas (fistulas) in the scrotum;
• epididymo-orchitis;
• necrosis of testicular tissue;
• infertility.

A potential consequence of severe infection is sepsis, or blood poisoning.

Prevention

Sexually active men can reduce their risk of contracting sexually transmitted infections by using condoms during sexual intercourse and having sex with a regular partner.

If symptoms of pain and discomfort in the scrotum do not go away within four days, you need to make an appointment with a urologist.

Any man who experiences urethral discharge, scrotal swelling, or testicular pain should refrain from sexual activity and seek immediate medical attention to prevent transmission of the infection to others and avoid long-term complications. It is important to treat acute epididymitis in a timely manner to minimize the risk of relapse.

In particular, you should definitely complete a full course of antibacterial therapy, even if an apparent improvement in your condition occurs before the end of treatment.