Recurrent Epididymitis: Causes, Diagnosis, and Fertility Concerns

Q: Recurrent Epididymitis: Causes, Diagnosis, and Fertility Concerns

Hello： 1) Epididymitis, based on outpatient experience, the lump takes a long time to resolve, usually several months before it gradually softens and decreases in size. <br>However, if there is tenderness, it is often indicative of a recurrence. <br>A urine test and culture can h

Recurrent epididymitis

Hello doctor, I have discomfort in my testicles after having unprotected oral sex.
I visited a clinic at the end of August, and the doctor diagnosed me with epididymitis.
I was prescribed Cephalexin antibiotics, and after recovery, it recurred three weeks later.
I took another three weeks of Cephalexin, and now it has recurred for the third time.
I have been tested for HIV, syphilis, and chlamydia, all of which came back negative.
However, there is a hard lump in my epididymis that does not hurt when touched, and I am experiencing weak urine flow and frequent urination.

Doctor, I have a few questions:
1.
What could my symptoms indicate, and how can I identify the pathogenic bacteria?
2.
Do I need to undergo further testing?
3.
Is there a possibility of infertility? Thank you.

Mr. Chen, 20~29 year old female. Ask Date: 2020/11/30

Dr. Du Shixi reply Urology

Hello: 1) Epididymitis, based on outpatient experience, the lump takes a long time to resolve, usually several months before it gradually softens and decreases in size.
However, if there is tenderness, it is often indicative of a recurrence.
A urine test and culture can help identify the causative bacteria.
2) Lifestyle precautions are essential; avoid alcohol and spicy foods, drink plenty of water, practice safe sex, and reduce the risk of recurrence.
3) A semen analysis can be performed to assess any potential impact on health.

Reply Date: 2020/11/30

More Info

Recurrent epididymitis can be a challenging condition to manage, especially when it recurs multiple times despite treatment. Based on your description, it seems that you have been experiencing recurrent episodes of epididymitis, which is inflammation of the epididymis, often caused by infection. Let's address your concerns one by one.

1. Possible Symptoms and Identifying Pathogens: The symptoms you are experiencing, such as discomfort in the testicular area, the presence of a hard lump in the epididymis, and urinary issues like weak stream and frequency, are consistent with epididymitis. The hard lump you mentioned could be a result of chronic inflammation or possibly an abscess. To identify the causative bacteria, a urine culture is typically performed, which can help detect any bacterial infections. Additionally, a urethral swab may be necessary to check for sexually transmitted infections (STIs) that might not have been detected in previous tests. If the standard cultures do not yield results, more specialized tests, such as a polymerase chain reaction (PCR) test, may be warranted to identify less common pathogens.

2. Further Investigations: Given that you have had multiple episodes of epididymitis, further investigations are advisable. An ultrasound of the scrotum can help assess for any structural abnormalities, such as a hydrocele or varicocele, and can also help visualize any abscess formation. If there is a suspicion of a chronic infection or if the hard lump persists, a biopsy may be considered. Additionally, evaluating your urinary tract with a urinalysis and possibly a cystoscopy could help rule out any underlying issues contributing to your symptoms.

3. Fertility Concerns: Regarding your concerns about fertility, recurrent epididymitis can potentially impact fertility, especially if it leads to scarring or blockage of the epididymis or if there is a significant impact on sperm quality. The inflammation can affect sperm transport, and if there is a chronic infection, it may also affect sperm production. However, many men with a history of epididymitis can still father children. It is essential to address the underlying cause of the recurrent infections to minimize any potential impact on fertility. If you are concerned about your fertility, it may be beneficial to consult a urologist who specializes in male reproductive health. They can perform a semen analysis to assess sperm count, motility, and morphology, providing a clearer picture of your fertility status.

In summary, recurrent epididymitis can be a complex issue that requires thorough investigation to identify the underlying cause and appropriate treatment. It is crucial to work closely with your healthcare provider to develop a comprehensive management plan that addresses both the infection and any potential fertility concerns. If you have not already done so, consider seeking a referral to a urologist for specialized care.

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