Epididymitis: Symptoms, Diagnosis, and Treatment Options

Epididymitis issues?

Doctor, I would like to inquire about my situation.
On June 12, I had unprotected intercourse with a sex worker.
The next day, I experienced severe itching in my scrotum, which turned into intense pain by June 17.
On June 19, I visited a urologist and had a urine test.
An ultrasound was performed, focusing on the area between the base of the penis and the testicles, but the ultrasound did not indicate any signs of inflammation.
However, I was given a carbapenem injection and prescribed doxycycline 100 mg, to be taken twice daily.
On the fifth day of taking the medication, I started to develop a rash and experienced severe palpitations and insomnia.
After completing the 14-day course, the itching in my scrotum returned the following day, and I began to feel pain again (not extremely severe, but noticeable).

On July 7, I returned for a follow-up, and the report indicated that the urine test for occult blood and urine culture from June 19 were normal, suggesting that it might be a psychological issue.
This discomfort continued until July 13, prompting me to see a different doctor.
The new doctor suggested that I might have testicular inflammation, which should not be related to testicular torsion or varicocele, and prescribed me 500 mg of a medication.
However, I experienced palpitations, insomnia, and a rash (which appeared on the third day).
Additionally, on July 12, I had a blood test for the fourth-generation HIV test, which came back negative.
My questions for the doctor are: Is it possible that the urine culture from the large hospital overlooked something, such as trichomoniasis? Also, does a standard urine occult blood test typically indicate whether there is inflammation in the testicles? Since the results were normal, but I still have drooping and pain in my testicles, should I hold my urine for a longer period before testing, considering I have a 2.5-hour interval without urinating?

Xiao Zhang, 20~29 year old female. Ask Date: 2023/07/16

Dr. Li Xinyi reply Urology

The diagnosis of sexually transmitted infections (STIs) can be quite challenging, especially if you have undergone multiple courses of antibiotic treatment.
My recommendation is to either closely follow up with a physician for empirical antibiotic therapy or visit a sexually transmitted disease prevention and control center, such as the one in Kunming, for examination and treatment.

Reply Date: 2023/07/16

More Info

Epididymitis is an inflammation of the epididymis, a tube located at the back of the testicle that stores and carries sperm. It can be caused by various factors, including bacterial infections, sexually transmitted infections (STIs), or non-infectious conditions. Understanding the symptoms, diagnosis, and treatment options for epididymitis is crucial for effective management.

Symptoms of Epididymitis
The symptoms of epididymitis can vary but typically include:
1. Pain and Swelling: The most common symptom is pain in the scrotum, which may be accompanied by swelling of the affected testicle. The pain can range from mild to severe and may worsen with movement or sexual activity.

2. Redness and Warmth: The skin over the affected area may appear red and feel warm to the touch.

3. Discharge: There may be a discharge from the penis, particularly if the cause is an STI.

4. Urinary Symptoms: These can include a frequent urge to urinate, burning sensation during urination, or blood in the urine.

5. Fever and Chills: In some cases, systemic symptoms like fever and chills may occur, indicating a more severe infection.

Diagnosis
Diagnosing epididymitis typically involves a combination of the following:
1. Medical History and Physical Examination: A healthcare provider will take a detailed medical history, including sexual history, and perform a physical examination to assess for tenderness, swelling, and other signs.

2. Urinalysis: A urine sample is often tested for signs of infection, such as white blood cells or bacteria.

3. Urine Culture: This test can help identify the specific bacteria causing the infection, which is crucial for determining the appropriate antibiotic treatment.

4. Ultrasound: An ultrasound of the scrotum may be performed to rule out other conditions, such as testicular torsion or tumors.

5. Blood Tests: In some cases, blood tests may be ordered to check for signs of infection or inflammation.

Treatment Options
The treatment for epididymitis depends on the underlying cause:
1. Antibiotics: If the epididymitis is caused by a bacterial infection, antibiotics are the primary treatment. Commonly prescribed antibiotics include doxycycline, azithromycin, or ciprofloxacin, depending on the suspected organism.

2. Pain Relief: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help alleviate pain and reduce inflammation.

3. Rest and Support: Resting and elevating the scrotum can help reduce discomfort. Wearing supportive underwear may also provide relief.

4. Follow-Up: It’s essential to follow up with your healthcare provider to ensure the infection is resolving and to address any ongoing symptoms.

Addressing Your Concerns
Based on your description, it seems you experienced symptoms consistent with epididymitis following unprotected sexual intercourse. The initial treatment with doxycycline was appropriate, but the subsequent development of a rash and palpitations may indicate a reaction to the medication. It’s important to communicate these side effects to your healthcare provider.

Regarding your concerns about urine culture potentially missing infections like trichomoniasis, it’s worth noting that standard urine cultures typically do not test for all STIs. If you suspect a specific STI, such as trichomoniasis, you may need targeted testing.

As for the urine tests, a normal urine analysis does not rule out epididymitis or testicular inflammation. The pain you are experiencing could be due to residual inflammation or another underlying issue. If the pain persists, further evaluation, including imaging or referral to a specialist, may be warranted.

Lastly, regarding your question about the timing of urine collection, it is generally recommended to collect a midstream urine sample after holding urine for at least 2-3 hours for the most accurate results. However, if you are experiencing significant discomfort, it’s best to consult your healthcare provider for personalized advice.

In conclusion, if your symptoms persist or worsen, or if you have concerns about your treatment, it is crucial to seek further medical evaluation to ensure appropriate management and care.

Similar Q&A

Understanding Epididymitis: Symptoms, Diagnosis, and Treatment Concerns

Hello, Dr. Hsu: About two weeks ago, I suddenly noticed a small lump on my left testicle while taking a shower. Initially, there was no pain, but in the past two days, I have experienced some discomfort when touching the lump. I visited a urologist, and the diagnosis was epididym...

Dr. Xu Weikai reply Urology
ChihPing: Hello, epididymitis is quite common and can be transmitted through two possible routes: 1. Via the urinary system: this means it can be transmitted through pathways such as the urethra. 2. Via the bloodstream: this means it can invade from the cardiovascular system. For...

Understanding Chronic Epididymitis: Symptoms, Treatment, and Fertility Concerns

Hello, I developed symptoms in September 2014. After receiving injections and taking antibiotics, I recently had an ultrasound last month, which indicated that I have epididymitis on the left side. Despite receiving intravenous treatment and medication, my condition has not impro...

Dr. Xu Weikai reply Urology
Xiao Liang: Hello, a diagnosis of chronic epididymitis is made when symptoms persist for more than six months without signs of bacterial infection. If epididymitis becomes chronic, it may result in permanent enlargement, but severe pain is uncommon; instead, there may be mild dis...

Understanding Acute Epididymitis: Symptoms, Treatment, and Self-Care Tips

Hello, Doctor! I haven't had sexual intercourse for almost four months, but recently when I had sex with my girlfriend, I noticed that my sperm had a yellowish color. I researched this on medical websites and learned about some conditions, one of which mentioned that it coul...

Dr. Xu Wencang reply Urology
Antibiotic treatment may need to continue for three weeks, with fever and elevated white blood cell count subsiding first, followed by improvement in pain. The swelling may persist for one to two months. Upon returning to Taiwan, further examinations can be conducted, including u...

Chronic Epididymitis: Exploring Advanced Treatment Options

Hello, Dr. Hsu! I have been suffering from epididymitis for a long time. I have taken antibiotics from first-line to third-line, but it still hasn't been cured since March. Urine tests have shown no bacterial infection. Sigh... I always have pain in my scrotum. It's rea...

Dr. Xu Weikai reply Urology
Justin: Based on my experience, chronic epididymitis generally does not require antibiotic treatment unless there is a concurrent infection. The principle of managing chronic epididymitis is symptomatic treatment. If there are any unclear points, feel free to ask again, and we ca...