Epididymitis: Symptoms and Treatment

Epididymitis is an infectious or noninfectious inflammation of the epididymis.The appendage is a spiral tube that is located on the posterior surface of the testicle and secures it to the vas deferens.

The disease can develop at any age, even in children.Epididymitis often develops in men during sexual activity.

In general, the infection first affects one testicle, but over time it can hit the second one.

Table of contents: Causes of epididymitis. Classification of epididymitis Symptoms of epididymitis

Causes of epididymitis

There are four main factors that contribute to the development of the disease:

1. Infectious:
   a) Nonspecific infection
   • fungi( candida albino and others.);
   • bacteria;
   • Chlamydia;
   • mycoplasma;
   • viruses.B) Specific infection
     • tuberculosis;
     • syphilis;
     • gonorrhea.

     Infection can penetrate the appendage through the blood vessels, urethra, lymphatic vessels and secretory pathways.
     Important! Bacterial infection is the causative agent of the disease in more than 80% of cases.

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   • Infectious-necrotic:
     a) The adnexa can become inflamed due to the torsion of the attachment of the appendage, which contributes to the attachment of the bacterial flora.
     b) The development of granulomatous epididymitis can provoke the introduction of spermatozoa into the epididymis tissue.
   • "Stagnant"
     Epididymitis can develop due to stagnation of blood in the spermatic cord and veins of the pelvis.Also, the cause may be excessive blood filling of the scrotum organs.
     Possible Causes:
     • frequent cycling;
     • sexual excesses;
     • masturbation;
     • interruption of intercourse;
     • hemorrhoids;
     • resistant locks;
     • frequent ejaculation without intercourse.
   • Traumatic
     In 9% of cases, epididymitis can develop as a result of scrotal injury, as well as after surgery or exposure to medical instruments.
     General developmental factors of the disease:
     • decreased immunity after severe diseases or complicated operations;
     • overheating or subcooling;
     • difficult flow of urine;
     • side effects of drugs;Asd91ASD
     • promiscuous sexual intercourse.

Classification of epididymitis

By the nature of the course of inflammation, the disease can be specific and unspecific

Classification by causative agent type:

• mycoplasma;
• are viral;
• chlamydial;
• bacterial;
• fungal.

Traumatic epididymitis is divided into three groups:

• is actually traumatic;
• post-instrumental;
• postoperative.

Process localization classification:

• single-sided;
• reversible.

Classification downstream:

• Acute epidermitis;
• chronic epidermitis;
• recurrent.

Symptoms of epididymitis

Acute form

The first symptom of the disease is acute pain in the ovary that can give to the perineum, groin or the area of ​​the sacrum .The disease develops rapidly and reaches its peak already a day after the appearance of the first signs.

The scrotum gradually swells, the skin turns red.Within 4 hours the size of the testicle can significantly increase.

The following symptoms may also be present:

• urine with an admixture of blood;
• enlarged lymph nodes in the groin;
• during stool or active movements, pain in the scrotum increases;
• increase in body temperature to 39-40 degrees;
• nausea and vomiting;
• may appear minor discharge from the urethra;
• chills;
• rapid urination.

After 2-5 days, all of the above symptoms become less pronounced.

Attention! At the first signs of acute form, you should immediately consult a doctor, otherwise the disease will go to chronic.

Chronic form

If the timely treatment of the acute form of the disease does not begin, it develops into a chronic form.In total, epididymitis can occur for more than six months. If acute symptoms occur immediately, then with chronic symptoms, symptoms are almost absent.The skin of the scrotum does not change color, and the testicle does not change shape.A man can feel discomfort only during an exacerbation of the disease.

In case of chronic course of the disease, the epididymis can increase several times and become denser.At palpation, painful sensations arise.The spermathecal duct becomes wider in diameter, and the spermatic cord grows thicker.

Diagnosis of the disease

If symptoms appear that are mentioned above, you should immediately contact a urologist. He will appoint a qualified treatment.The patient can be referred to a hospital for a more complete examination.

The doctor first conducts a survey and examination of the patient .A rectal examination of the prostate, the cupern glands and seminal vesicles is performed.This method will identify the presence of infection and identify possible causes, such as prostate adenoma and prostatitis.

Laboratory diagnostics will help determine the degree and intensity of inflammation.It includes:

1. General blood test:
   • In the bacterial flora, there is an increased level of leukocytes, a decrease in white blood cells indicates a viral lesion.
   • An increase in the level of monocytes indicates a specific infection( brucellosis, tuberculosis, etc.).
   • Acceleration of ESR.
2. Biochemical blood test:
   • A high level of creatine also indicates kidney failure.
   • Increased content of C-reactive protein.
   • The level of gamma globulins is increasing.
3. General urine analysis
   Leucocytes in urine indicate that there are also diseases of the urinary system.
4. Spermogram With inflammation in the seminal vesicles and the prostate gland, there will be an increase in the number of leukocytes.

Detection of the causative agent of epididymitis:

1. Bacteriological study and direct microscopy methods are used to determine the causative agent of the disease.With direct microscopy, the material taken is stained and examined under a microscope.Bacteriological research includes the sowing of material on nutrient media in which the desired microorganism will multiply.For the study, the following materials are taken: urine, a scaphoid from the scaphoid urethra, semen, the secretion of the prostate gland.
2. Modern immunological methods are used for diagnostics.

Instrumental diagnostic methods:

• MRI.This study will help to accurately assess the condition of the epididymis and testicular tissues.
• US . Allows you to quickly and accurately determine the nature of lesions.But it is not always possible to establish exactly the stage of inflammation and to detect microabscesses.

Complications of epididymitis

Complete recovery is guaranteed only with proper and timely treatment.In this case, the disease does not affect sexual activity and reproductive capacity.

Important! The later the treatment begins, the greater the likelihood of complications.The chances of a favorable outcome of treatment are significantly reduced.

Possible complications:

• development of a serious infectious process;
• scrotum abscess;
• fistula formation in the skin of the scrotum;
• transition of the disease into a chronic form;
• formation of adhesions between the testis and scrotum;
• development of bilateral epididymitis;
• infringement of a blood supply of a testicle with the subsequent hardening of its tissues.

Important! In 40-60% of cases epididymoorkhitny inflammatory process leads to functional death of the epididymis and testicles, which leads to infertility.Often occurs with bilateral epididymitis.

Mechanisms for the development of infertility:

• the effect of infection on spermatozoids;
• disrupted the secretion of the gonads;
• affects the tubules through which sperm move, which prevents normal maturation and excretion of spermatozoa;
• immune mechanisms are broken, resulting in the formation of antibodies against their own structures.

Treatment of epididymitis

Diet and regimen of

In case of worsening of the disease, it is very important to adhere to all the recommendations of the doctor and observe a strict bed rest.Also it is necessary to provide an elevated position and immobility of the scrotum.This can be done with a roller-folded towel or special swimming trunks.

First aid is to apply cold compresses or ice wrapped in cloth to the scrotum.They are put on for a couple of hours at intervals of half an hour.This will help relieve pain and swelling.

To exclude from the diet fried and spicy dishes, pickles, smoked products and spices.It is necessary to use a lot of liquid.

Medical therapy

Complex treatment is carried out, which includes:

• antibacterial therapy;
• resorptive drugs;
• vitamins;
• anti-inflammatory drugs.

Antibiotic drugs are prescribed depending on the sensitivity to antibiotics and the causative agent of the disease.As a rule, two antibiotics are prescribed simultaneously.

Patients under 40 years of age( if the epididymitis is caused by sexually transmitted infections) is prescribed a combination of Rocefina or Ceftriaxone( intramuscularly or intravenously) with Azithromycin .The course is 5 days.Ceftriaxone may be combined with Doxycycline in tablets, or with Sumamed.The course of antibiotics is prescribed for 10 days.Doses the doctor appoints individually to each patient.Both partners are being treated.

Patients who do not have sexually transmitted diseases receive a 2-week course of treatment with Ciprofloxacin, Trimethoprim, Zanocin, Cipranol and Levofloxacin, Sulfamethoxazole.

If the treatment does not give the desired results, the doctor may prescribe other drugs, or change the course of treatment.Along with antibacterial drugs prescribed painkillers and anti-inflammatories, vitamins.

In non-infective epididymitis, an anti-inflammatory therapy is prescribed by a urologist.If epididymitis develops as a result of taking Amiodarone, it is necessary to consult a cardiologist to replace the drug or reduce the dose.

After medical therapy, physiotherapeutic treatment is prescribed: UHF, diathermy, etc.

Surgical treatment

Surgery is indicated for acute and chronic epididymitis in the following cases:

• infertility due to obstruction of the epididymis;
• suppuration of epididymis;
• tuberculous epididymitis;
• abscess of epididymis or testis by ultrasound;
• frequent recurrences in chronic form;
• orcoepididymitis or acute post-traumatic epididymitis;
• severe form of acute epididymitis and lack of positive treatment results;
• torsion of the epididymis or testis.

In surgical treatment, the following operations are used:

• notch method;
• removal of the testis and appendage;
• puncture of the scrotum cavity;
• removal( resection) of the appendage;
• removal of the epididymis.

The operation is selected depending on the course of the disease and the presence of complications.

Folk remedies for the treatment of epididymitis

The following folk remedies are used for the treatment of the disease:

• Take equal parts of the root of the stalker, birch leaves, goose goblet, celandine and cones of juniper.Mix it.Add 4 tablespoons of the mixture and fill with a liter of boiling water.Cool and strain infusion.Take three times a day for a glass.
• For collection, take in equal parts birch buds, corn stigmas, violet, bean pods.Take two spoons of collection, pour a liter of boiling water, insist 20 minutes, strain and drink three spoons three times a day.
• Collect from an equal number of flowers of tansy, cowberry leaf and horsetail.Take two spoons of the collection, pour 1.5 tbsp.Boiling water and insist half an hour.Strain.Take in the morning and evening for 200 ml.

Attention! Treatment with folk remedies is a supplement to the basic.Before using any prescription, consult a doctor.

Prevention of disease

• Compliance with personal hygiene.
• The practice of safe sex( using a condom) to prevent sexually transmitted diseases.
• Beware of injuries to testicles;
• Frequent sexual intercourse, masturbation and agitation, which does not result in ejaculation, can lead to inflammation of the appendages.
• Timely treatment of pelvic and urogenital diseases.
• Do not allow subcooling.

Timely treatment started will protect against loss of important hormone-producing organs, or such serious complications as infertility.If the first signs appear, consult a specialist immediately and take a complete examination.

Radevich Igor Tadeushevich, a sexually pathological andrologist of the 1st category