Acute Epididymitis: Symptoms, Diagnosis, and Treatment

Q: Acute Epididymitis: Symptoms, Diagnosis, and Treatment

Hello： This platform is for reference only and cannot replace a physician's personal examination. <br><br>1) Is the diagnosis of acute epididymitis correct? If not, what other issues could it possibly be? --> The accuracy of the diagnosis cannot be confirmed. <br>If you have conc

Acute epididymitis with swelling and discomfort?

Hello Doctor, about five days ago, I visited a clinic due to swelling below my left testicle, fever, and blood in my semen.
After a physical examination, the doctor diagnosed me with acute epididymitis and conducted tests for chlamydia and gonorrhea (both results were negative).
I also started treatment with antibiotics (cefixime and doxycycline) and began applying warm compresses since the day before yesterday.
Today, five days later, there is still a non-elastic, droplet-shaped hard lump (about one centimeter in size) with tenderness remaining at the lower back of the testicle, showing no signs of improvement.
I would like to ask the doctor: 1) Is the diagnosis of acute epididymitis correct? If not, what other issues could it possibly be? 2) I read in a Q&A that the swelling may take several weeks to resolve.
Is it normal for the tenderness not to improve in my case, or should I seek further medical follow-up? Thank you very much!

Niming, 20~29 year old female. Ask Date: 2022/05/14

Dr. Du Shixi reply Urology

Hello: This platform is for reference only and cannot replace a physician's personal examination.

1) Is the diagnosis of acute epididymitis correct? If not, what other issues could it possibly be? --> The accuracy of the diagnosis cannot be confirmed.
If you have concerns, consider consulting a urologist at a hospital.
2) I read in the Q&A that the swollen area may take several weeks to resolve.
Is it normal for my tenderness not to improve, or should I seek further medical follow-up? --> Generally, symptoms will gradually improve after treatment, but complete pain relief may take about a week.
Maintain a normal diet and hydration.
If the mass continues to enlarge or if other new symptoms arise, you should see a physician promptly.
Wishing you good health.

Reply Date: 2022/05/14

More Info

Acute epididymitis is an inflammation of the epididymis, a coiled tube located at the back of the testicle that stores and carries sperm. It is often caused by infections, and in sexually active men, it is frequently associated with sexually transmitted infections (STIs) such as Chlamydia and Gonorrhea. However, other non-sexually transmitted infections can also cause acute epididymitis, particularly in older men.

Symptoms of Acute Epididymitis
The symptoms you described—swelling in the area below the left testicle, fever, and blood in the semen (hematospermia)—are consistent with acute epididymitis. Other common symptoms include:
- Pain and tenderness in the affected testicle
- Swelling of the scrotum
- Pain during urination or ejaculation
- Discharge from the penis (if an STI is involved)
- A feeling of heaviness in the affected testicle

Diagnosis
Your physician's diagnosis of acute epididymitis seems appropriate given your symptoms and the negative test results for Chlamydia and Gonorrhea. The absence of these STIs does not rule out the condition, as other bacteria or viral infections can also cause epididymitis. In some cases, conditions such as urinary tract infections or prostatitis can lead to epididymitis, especially in older men.

Treatment
The treatment you are receiving, which includes antibiotics (cefixime and doxycycline), is standard for managing acute epididymitis. These medications target a broad range of bacteria that could be responsible for the infection. Additionally, supportive care such as rest, scrotal elevation, and warm compresses can help alleviate symptoms.

Concerns About Persistent Symptoms
Regarding your concern about the persistent hard lump and tenderness after five days of treatment, it is not uncommon for swelling and discomfort to persist for a period of time following the initiation of antibiotic therapy. In many cases, the inflammation can take several weeks to fully resolve, and the hard lump you are feeling could be a result of the inflammation or a localized collection of fluid (such as a hydrocele or a spermatocele).

However, if the lump remains painful or does not show signs of improvement after a week or two, it is advisable to follow up with your healthcare provider. They may consider further evaluation, which could include:
- An ultrasound of the scrotum to assess for any complications such as abscess formation or other abnormalities.

- A reevaluation of your symptoms and possibly adjusting your treatment plan.

Conclusion
In summary, your diagnosis of acute epididymitis appears to be correct based on your symptoms and initial testing. While it is normal for some symptoms to persist, it is essential to monitor your condition closely. If you experience worsening symptoms, increased pain, or if the lump does not improve, seeking further medical evaluation is warranted. Always communicate openly with your healthcare provider about any concerns you may have regarding your treatment and recovery.

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