Epididymo-orchitis In men over the age of 35 years the most Epididymo-orchitis Bladder common cause is a urine infection – with local Seminal spread of infection from the bladder. This may Epidiymo-orchitis – the basics vesicle Epididymo-orchitisIt is a condition- the basics affecting men characterised by also occur after surgical procedures such as pain and swelling inside the scrotum (ball bag) Prostate Rectum cystoscopy or catheterisation. Epididymo-orchitisand is due a to condition an infection either that in causesthe: pain and Urethra Occasionally it may also be due to a ‘gut’ swelling inside the scrotum (ball bag). epididymis – tube carrying the sperm from bacterial infection from insertive anal Te s t i s the testicle to the vas deferens and then the intercourse. It is due to an infectionurethra either or water in pipe the: (epididymitis) Rarely epididymo-orchitis may be caused by Penis • epididymistesticle – tube (orchitis) carrying the sperm from the other infections such as mumps or tuberculosis. testicle to theepididymis vas deferensand testicle (epididymo-orchitis)and then the Vas urethra or water pipe (epididymitis) deferens What would I notice if I had epididymo-orchitis? • In men under the age of 35 years it is usually A rapid onset of pain and swelling in one or testicle (orchitis) Epididymis caused by a sexually transmitted infection (STI) sometimes both of your testicles. • epididymisin theand water testicle pipe e.g. (epididymo chlamydia or gonorrhoea.-orchitis) Scrotal Te s t i s Some men may also notice a discharge from Skin Prompt medical assessment is needed to the tip of the water pipe and/or pain on passing In people undermake 35 sure theyou don’t infection have a twisted is testicle often sexually urine. transmitted e.g. (testicular chlamydia torsion) or as thisgonorr can resultho eina long. B acteria or viruses transferredterm into damage the to urethra the testicle such if not as dealt following with sex or Occasionally you may feel generally unwell with a surgical procedurequickly. can cause epididymo-orchitis, as can a fever. non-infectious causes. How common is epididymo-orchitis? If you have epididymo-orchitis we recommend How do I get tested for epididymo-orchitis? It occurs most commonly in men aged 19- 40 Another conditionthat that you should causes have routine similar tests symptoms for all as epididymo-orchitis in young people is called Epididymo-orchitis is diagnosed by a medical years. testicular torsion.sexually This transmittedis where infections the testicle including may twist around in the ball bag. It causes sudden onset assessment, sexual health screen and urine test. severe pain and swellingchlamydia, gonorrhoea,and may syphilisresult and in HIV.long-term damage to the testicle if not dealt with quickly. It is treated immediately at your frst visit to the How do you catch epididymo-orchitis? clinic. Epidiymo-orchitis is easily treated with In men under the age of 35 years the most antibiotics, painkillers and rest but the pain common cause is a sexually transmitted infection If there is any concern about a possible torsion How common is epididymofrequently takes- orchitis?weeks to months to totally (STI) such as chlamydia or gonorrhoea with local of the testicles you will be referred immediately settle. spread from the water pipe. to Accident and Emergency for further It occurs most commonly in people aged 19- 40 years. assessment and investigations.

How do you develop epididymo-orchitis?

In people under the age of 35 years the most common cause is a sexually transmitted infection (STI) such as chlamydia or gonorrhoea.

In people over the age of 35 years the most common cause is a urine infection.

Occasionally it may also be due to a ‘gut’ bacterial infection from penetrative anal sex.

Rarely epididymo-orchitis may be caused by other infections such as mumps or tuberculosis.

What would I notice if I had epididymo-orchitis?

Pain and swelling inside the scrotum (ball bag).

Some people may also get pain on urination, a discharge from the urethra (water pipe), or feel unwell with a fever.

How do I get tested for epididymo-orchitis?

If the health professional suspects you have epididymo-orchitis they may examine your penis and ball bag, and take urine tests, blood tests and a swab from the urethra (water pipe). We recommend that you have routine tests for sexually transmitted infections including chlamydia, gonorrhoea, syphilis and HIV.

If there is any concern about a possible torsion of the testicles you will be referred immediately to the emergency department (A&E) or Urology team for further assessment and investigations.

How is epididymo-orchitis treated?

Epididymo-orchitis is usually diagnosed on the day and treatment started. It is easily treated with antibiotics, painkillers and rest but the pain frequently takes weeks to months to totally settle. All treatments at sexual health clinics are free and given to you in the clinic or their linked pharmacy. Supportive underwear or scrotal support (available from online retailers) may help ease the pain and swelling.

In some patients (e.g. where a bacterial infection is found in the urine or bladder), a diagnosis of epididymo-orchitis may mean that further tests are needed.

If your symptoms get worse or fail to improve within 3 days you should re-attend the clinic or seek further medical advice.

What about my partners?

If you have been diagnosed with an STI then any sexual partners you have had within the preceding 2-4 weeks need to have a full sexual health screen. Your clinic will advise you further about this.

When can I have sex again?

As epididymo-orchitis can be caused by sexually transmitted infections It is best that you do not have sexual intercourse until you have completed treatment and your partner has been tested and where applicable, treated. Your clinic will advise you further about this.

What happens if my epididymo-orchitis is left untreated?

Left untreated, epididymo-orchitis can result in

• Continued pain and swelling of the testicle • Accumulation of fluid around the testicle • A collection of pus in the scrotum • Very rarely, shrinkage of the testicle and loss of fertility

This leaflet was produced by the Clinical Effectiveness Group of the British Association for Sexual Health and HIV (BASHH). The information in the leaflet is based on the ‘United Kingdom BASHH national guideline for the management of epididymo-orchitis, 2019’ published by BASHH.

More information:

BASHH: www.bashh.org/guidelines

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Copyright BASHH 2021. This leaflet was first published MM 2021. Revision date MM 2024.