Acute epididymitis is a clinical syndrome consisting of pain, inflammation, and irritation of the epididymis that lasts 6 weeks. Sometimes the testis is also involved a condition referred to as epididymo-orchitis. A high index of suspicion for spermatic cord torsion must be maintained in men who present with a sudden onset of symptoms connected with epididymitis, as this situation is a surgical emergency.
Chronic epididymitis is characterized by a 6 week history of symptoms of discomfort and/or pain in the testicle, scrotum, or epididymis. Chronic infectious epididymitis is most commonly seen in conditions linked with a granulomatous reaction; Mycobacterium tuberculosis is common granulomatous disease affecting the epididymis and should be suspected, particularly in men with a known history of or recent exposure to tuberculosis. The differential diagnosis of constant non-infectious epididymitis, sometimes termed orchalgia/epididymalgia is broad; men with this diagnosis should be referred to an urologist for clinical management
To stop complications and transmission of sexually transmitted infections, presumptive therapy is indicated at the time of the visit before all laboratory test results are accessible. Selection of presumptive therapy is based on risk for chlamydia and gonorrhea and or enteric organisms.
The goals of Epididymitis Treatment are microbiologic cure of infection, development of signs and symptoms, prevention of transmission of chlamydia and gonorrhea to others, and reduce in potential chlamydia, gonorrhea epididymitis complications. Although most men with acute epididymitis can be treated on an outpatient basis, referral to a specialist and hospitalization should be considered when severe pain or fever suggests other diagnoses (e.g., testicular infarction, torsion, abscess, and necrotizing fasciitis) or when men are unable to comply with an antimicrobial routine. Because high fever is uncommon and indicates a complex infection, hospitalization for further evaluation is recommended.