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New Treatments for Epididymitis

The epididymis is located along the posterior border of the testicle with the head. Epididymitis is an inflammation of the epididymis that causes pain and swelling of the epididymis and often of the adjacent testicle. It may be accompanied by abdominal pain and fever. It is usually seen in young men but may occur at any epididamitis.

It was thought at one time that most cases of epididymitis were idiopathic, but more recent evidence suggests that most cases result from retrograde spread of infection from the bladder or urethra. In heterosexual men younger than 35 years, genital infection with either Chlamydia trachomatis or N. gonorrhoeae is the most common cause of epididymitis. The pathogens initially become established in the urethra and may not cause symptoms. The organisms then spread in a retrograde manner to the epididymis and result in the clinical syndrome of acute epididymitis. In older men, in some young boys, and in homosexual men who practice anal intercourse, the common pathogens are the coliform bacteria that usually cause urinary infection. Men who have neurologic disease and abnormal voiding or who require an indwelling catheter are especially at risk for urethritis and epididymitis and may have particularly severe infections. Young boys who have no pyuria or urethritis may have nonbacterial or sterile inflammations of the epididymis and hence not require antibiotic therapy.

 Unusual systemic infections such as tuberculosis or systemic fungal infections occasionally result in blood-borne infection of the epididymis. The antiarrhythmic drug amiodarone (Cordarone) can cause epididymitis that is usually confined to the head of the epididymis. Lastly, a chronic epididymitis can occur many years after vasectomy. It is thought to be related to the surgical obstruction and development of sperm.

TREATMENT

Treatment is directed at the likely underlying cause. Antibiotic therapy is usually indicated, and supportive treatment consists of bed rest, elevation of the scrotum, and analgesics. In young men in whom chlamydial or N. gonorrhoeae infection is most likely, treatment with one of the tetracyclines is usually indicated. Doxycycline (Vibramycin) may be given in a dose of 200 mg initially and then 100 mg twice a day for 10 to

Tetracycline (Achromycin), 500 mg orally four times a day, may be used but will produce a greater incidence of gastrointestinal side effects. If Gram's stain suggests Neisseria gonorrhoeae infection, ceftriaxone (Rocefin), 250 mg, is administered intramuscularly. Alternatively, ciprofloxacin (Cipro), 500 mg twice a day for 3 days, can be administered. In older males and young boys with concomitant urinary tract infection, an agent directed toward the coliform bacteria is usually indicated. Initial treatment can be with trimethoprim-sulfamethoxazole (Bactrim, Septra), 1 double-strength tablet twice a day for 10 days or, particularly in patients with complex urinary problems, one of the fluoroquinolones.

Prepubertal boys without pyuria or urethral discharge may be treated with scrotal support and analgesics and may not require antibiotic therapy. The major concern is to rule out testicular torsion. Patients with amiodarone-related epididymitis can be treated by reducing the dosage of the drug or changing to another agent if possible.

Postvasectomy epididymitis can occasionally be bothersome many years later. It is usually treated with nonsteroidal analgesics such as ibuprofen (Motrin) 400 mg four times a day for 10 to 14 days. Persistent pain and swelling with this or any other form of epididymitis.