The British Association of Urological Surgeons 35-43 Lincoln’s Inn Fields London WC2A 3PE Phone: Fax: Website: E-mail: +44 (0)20 7869 6950 +44 (0)20 7404 5048 www.baus.org.uk [email protected] CHRONIC EPIDIDYMITIS FREQUENTLY-ASKED QUESTIONS What is the epididymis? Behind each testis lies a structure called the epididymis. Sperms produced in the testis pass through tiny channels into the epididymis where they are stored. Their ability to swim is enhanced by chemicals produced within the epididymis. If you hold the testis between your fingers, you may be able to feel the epididymis as a ridge behind the testis. It is most prominent at the top and bottom of the testis (the head & tail of the epididymis). What is chronic epididymitis? This is uncomfortable swelling of part of the epididymis. In some cases, a clear infection is the cause but this is actually uncommon. In most patients, we never find any infection and the cause is unknown. The problem is called “chronic” because it comes and goes over a period of time. Acute epididymitis This is a different condition which affects the testis as well (epididymo-orchitis). It is usually due to bacterial infection and can cause a lot of pain and swelling. It may even result in emergency admission to hospital. It requires antibiotic treatment for at least six weeks. Most patients need further investigation to determine the cause of the infection. A full course of treatment is essential because incomplete treatment can cause the infection to become chronic. What are the symptoms of chronic epididymitis? The commonest symptom is a low-grade ache in the testicle. It is often difficult to localise the discomfort precisely with your fingers. The pain often radiates into the scrotum, into the groin or into the thigh and lower back. Sitting for prolonged periods of time may make it worse. If you have a genuine infection, you may notice an alteration in the colour or consistency of your semen. In a few patients, inflammation also affects the prostate. This can cause discomfort in the groins, back or thighs and may affect passage of urine. Page 1 What tests will be done? You GP or urologist will listen to your symptoms and examine you. Most tests are unnecessary but, if there is any suspicion that you have an underlying testicular lump, an ultrasound scan of the scrotum may be recommended. Culture of the semen for bacteria is rarely performed because it does not help in diagnosis. What can be done about it? If there is a definite infection, you will be given an antibiotic (Doxycycline, Co-Amoxiclav, Ofloxacin or Trimethoprim). Most patients, however, do not need antibiotics and respond to treatment with antiinflammatory drugs. The nost effective is Ibuprofen, which you can buy in chemists or supermarkets. You should take 400mg three times daily and continue this for a minimum of 14 days. If you develop heartburn or indigestion whilst taking these tablets, you should take an antacid. You should not take anti-inflammatory drugs if you have a history of stomach ulceration or if you have asthma. Supporting underwear often helps relieve discomfort. You cannot transmit this condition to your sexual partner unless there is a proven infection. Once antibiotics have removed any infection, there is no risk to your partner. Will this treatment cure me? Unfortunately, not always. Some patients only ever suffer a single episode but many patients suffer a recurrence months or even years later. If treated at an early stage with anti-inflammatory drugs, symptom progression can be prevented. It is always worth keeping a supply of tablets close at hand, especially if you are away from home for any period of time. Early treatment will minimise the discomfort you experience and may shorten the duration of the symptoms. Are there any other important points? This booklet contains guidelines and advice from professional bodies, together with information about the prescription of drugs. All NHS hospitals have local arrangements with their Primary Care Trusts (PCTs) about which medicines can be used. As a result, some drugs mentioned cannot be prescribed by local hospitals. Treatment of patients will be planned with the doctor responsible for care, taking into account those drugs which are or are not available at the local hospital and what is appropriate for optimum patient care. Healthcare professionals are advised to check prescribing arrangements with their local hospital or PCT. CHRONIC EPIDIDYMITIS Page 2 Disclaimer While we have made every effort to be sure the information in this booklet is accurate, we cannot guarantee there are no errors or omissions. We cannot accept responsibility for any loss resulting from something that anyone has, or has not, done as a result of the information in this booklet. © British Association of Urological Surgeons (BAUS) Limited Published: March 2014 Due for review: March 2015 CHRONIC EPIDIDYMITIS Page 3