Epididymitis/Orchitis

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Treatment

Treatment for epididymitis and epididymo-orchitis involves treating the underlying cause, if possible, such as using antibiotics to treat bacterial infections and treating urinary blockage (e.g., enlarged prostate treatment). Common side effects of antibiotics include upset stomach and diarrhea.

When a sexually transmitted infection is the cause, recurrence can be prevented if the sexual partner is also treated, even if the partner does not have symptoms. Treatment for mumps orchitis and trauma-related epididymitis is limited to managing symptoms. If the drug amiodarone is the cause, the inflammation usually goes away after the drug is discontinued.

Pain and inflammation may be treated with nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., aspirin, ibuprofen), rest, ice, elevation, and wearing scrotal support. Lying down with the scrotum elevated above heart level, by placing a rolled towel under the scrotum, may help to relieve pain and swelling and can promote healing.

Drinking plenty of water can also help speed recovery from infection. NSAIDs can cause stomach pain, ulcers, and rarely, kidney problems. Chronic pain may be treated with specialized pain management methods.

Surgery may be needed in severe cases with complications (e.g., abscess, death of a testicle). Also, chronic epididymitis is sometimes resolved with surgical removal of the epididymis. Tuberculous epididymitis might resolve with TB treatment, but damage can be severe and may require surgical removal of the testicle and/or epididymis.

Surgical removal of the epididymis or testicle leads to loss of sperm production on the affected side. If both testicles or both epididymes are removed, infertility results. Surgical complications include damage to nearby structures, which may cause fertility problems or pain.

With treatment, most acute cases improve within a few days. If not, a doctor should be contacted. Complete relief of symptoms may take weeks or months. For example, TB cases that are treated with medications take months for treatment and complete recovery. After the prescribed treatment is completed, patients should follow up with the doctor. Chronic cases usually require ongoing treatment for symptoms.

Prognosis

In most acute cases, normal function of the testicles and epididymes returns if the underlying problem is treated adequately. Mumps orchitis usually resolves by itself within a few days, although atrophy (shrinkage) may remain. Chronic cases are difficult to treat, and even surgical removal of the testicle may not successfully relieve pain in the scrotal area.

In some cases, these conditions result in lasting atrophy, fertility problems, or testosterone deficiency. Patients who closely follow the instructions of a qualified health care provider have the best outcomes.

Prevention

Since the most common cause for acute cases is a sexually transmitted infection, safer sex (e.g., use of latex condoms during sex) can significantly reduce the risk for infection of the epididymes and testicles. Treating underlying bladder obstruction problems (e.g., enlarged prostate treatment) and limiting mumps exposure are also important. Mumps prevention includes getting the MMR (mumps, measles, rubella) vaccine and limiting exposure to people who are infected.

Reducing the use of urinary catheterization, or ensuring proper methods, may also help prevent inflammation and infection. Appropriate medical care can help reduce the risk for infection in men with compromised immunity.

Epididymitis/Orchitis, Treatment, Prognosis reprinted with permission from urologychannel.com
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