Epididymitis

The epididymis is a structure of tubules that transport sperm from the testicle. It is palpable on physical examination on the posterior or rear of the testicle. The tubules within the epididymis merge to form the vas deferens. The vas deferens is the tube that is cut during a vasectomy to prevent sperm from mixing with the remainder of ejaculatory fluid.

Epididymitis is an inflammation or infection of the epididymis. This can occur as the result of trauma or infection. Frequently, the cause is not determined. Symptoms of epididymitis include discomfort in the region of the testicle. This pain and tenderness is often referred into the groin and occasionally into the abdomen. Swelling and firmness in these tissues can also be a component of epididymitis. As with any change in testicular exam or sensation, this should be examined by a physician.

Acute epididymitis is self-limited and, with good immune support and appropriate medical care, will resolve without complications. Chronic epididymitis is uncommon and is generally seen as an irreversible end stage of a severe acute attack which has not been treated or has not responded, and has been followed by frequent mild attacks.

Organisms associated with epididymitis include chlamydia trachomatis, cryptococcus neoformans, hemophilus influenzae (rare), mumps, mycobacterium tuberculosis, nisseria gonorrhea, nisseria meningifidis, salmonella typhi (rare), various filaria (tropical regions only). Chlamydia trachomatis may be the major cause of acute epididymitis in men under 35 years of age. Epididymitis from an STD like this will generally present with urethritis.

Treatments of epididymitis include antibiotic therapy, anti-inflammatories, and scrotal support. Bedrest and local ice for the first 48 hours is very beneficial. Cold therapy can be used for acute epididymitis. An athletic supporter will further relieve pain once normal activity is resumed. Emptying the bladder prior to strenuous activity is a good idea, strenuous activity should be interrupted if there is a sensation of a full bladder. In cases where the epididymitis has progressed to a firmness or induration of the tubules, treatment usually produces relief of the pain prior to complete resolution of firmness of the inflamed tissues. Diabetics and other individuals with underlying systemic illnesses are more susceptible to this type of infection.

Sexual partners should also be tested for chlamydia.

 


Signs, symptoms & indicators of Epididymitis

Symptoms - Metabolic  

Having a slight/having a moderate/having a high fever



Symptoms - Reproductive - General  

(History of) enlarged testical or enlarged testes



 

Painful testicles or painful testicle



 

Painful ejaculation rarely or painful ejaculation



Counter Indicators
Symptoms - Reproductive - General  

Absence of painful ejaculation



 

Absence of painful testicle



 

Absence of enlarged testical




Conditions that suggest Epididymitis

Symptoms - Reproductive - General  

Chronic/acute epididymitis



Counter Indicators
Symptoms - Reproductive - General  

Absence of epididymitis




Risk factors for Epididymitis

Infections  

STD Gonorrhea

Men may suffer from infertility following gonorrhea if the epididymis is scarred.




Recommendations for Epididymitis

Botanical  

Goldenseal (Hydrastis canadensis)

Berberine-containing herbs are effective antibacterial agents. Since berberine has been shown to inhibit chlamydia trachomatis, berberine with bromelain is an excellent choice for “idiopathic epididymitis”. Dose of Golden Seal: 0.5 to 1.0gm TID of the dried root.



Digestion  

Bromelain

As the kinins and prostaglandins of inflammation are inhibited by the action of bromelain, the decreased inflammation reduces recovery time. Antibacterial agents should be combined with the bromelain except where trauma is clearly the cause of the problem. With trauma, bromelain, bedrest, ice and support is recommended. Bromelain may enhance the efficacy of the antibacterial herbs by increasing the permeability of the blood:testis barrier. Dose: 250mg 4x/day (between meals).



Drug  

Antibiotics

When a positive urine culture has identified an organism, it can be specifically treated and, as with all infections, the immune system should be supported.



Oxygen / Oxidative Therapies  


Key

Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Weakly counter-indicative
Strongly counter-indicative
Very strongly or absolutely counter-indicative
May do some good
Likely to help
Highly recommended

Glossary

Acute

An illness or symptom of sudden onset, which generally has a short duration.

Chronic

Usually Chronic illness: Illness extending over a long period of time.

Chlamydia

A sexually-transmitted disease that is often without symptoms. Some females experience a white vaginal discharge that resembles cottage cheese, a burning sensation when urinating, itching, and painful intercourse. A clear watery urethral discharge in the male probably is a chlamydia infection.

Tuberculosis

Also known as TB, Consumption or "The White Plague", tuberculosis is an infectious disease caused by a bacterium called Mycobacterium tuberculosis, usually affecting the lungs but possibly also the brain, kidneys and bones. Patients may at first be symptom-free or experience a flu-like illness. In the secondary stage, there might be a slight fever, night sweats, weight loss, fatigue and various other symptoms, depending on the part of the body affected. Tuberculosis of the lung is usually associated with a dry cough that eventually leads to a productive cough with blood-stained sputum. There might also be chest pain and shortness of breath.

Gonorrhea

A sexually-transmitted disease that is often without symptoms. If there are symptoms in the female, they include frequent and painful urination, cloudy vaginal discharge, vaginal itching, inflammation of the pelvic area, and abnormal uterine bleeding. If the male has a purulent (pus-like) urethral discharge, he should assume he has gonorrhea until proven otherwise.

Diabetes Mellitus

A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.

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