Epididymitis

Also called Epididymo-orchitis, Inflamed testicle

Infection or inflammation behind the testicle. The job of the first assessment is to exclude torsion, which is a surgical emergency.

What it is

Inflammation of the epididymis, the coiled tube behind the testicle, usually from infection. When the testicle is involved too it is called epididymo-orchitis.

In men under about 35 the usual cause is a sexually transmitted infection, most often chlamydia or gonorrhoea. In older men it is more often a urinary organism, associated with an enlarged prostate, a catheter or recent instrumentation.

**The first question is always whether this is testicular torsion instead.** Torsion has a six-hour window and loses the testicle if missed. Epididymitis usually comes on over a day or two, with fever and urinary symptoms; torsion comes on over minutes to hours, often with vomiting. The distinction is not reliable enough to make at home, and in a young man sudden testicular pain goes to A and E.

Treatment is antibiotics chosen for the likely cause, which differ substantially between the sexually transmitted and urinary pictures, so getting the right assessment matters.

Untreated it can cause an abscess, chronic pain, or reduced fertility.

Mumps orchitis is a distinct viral cause, and is prevented by MMR vaccination. See mumps.

Signs you might notice

Gradual onset of pain and swelling in one testicle and behind it, over a day or two.

Redness and warmth of the scrotum.

Fever and feeling unwell.

Urinary symptoms: burning, frequency, or discharge from the penis.

Pain relieved somewhat by lifting the testicle, which is suggestive but not reliable enough to depend on.

**A and E immediately** for sudden severe testicular pain, especially with vomiting, especially in a boy or young man. Assume torsion.

Also urgent: a very swollen, red, extremely tender scrotum with high fever, which may be an abscess or a spreading infection.

Any testicular lump that is painless and persistent needs assessment for testicular cancer.

How it can affect day-to-day life

Recovery is slower than people expect. Swelling and discomfort commonly take several weeks to settle fully, and a lingering firm area can persist for months, which causes unnecessary alarm unless it is explained.

Scrotal support, rest, ice and anti-inflammatories genuinely help in the first days.

Where a sexually transmitted cause is found, partner notification and treatment is essential and often the part that does not happen.

In older men, a first episode should prompt a look at the prostate and bladder emptying rather than being treated in isolation.

Chronic scrotal pain after an episode is a recognised and difficult problem, and repeated antibiotic courses do not help it; it needs a pain-focused approach.

Fertility concerns are common and rarely raised by the person; a semen analysis some months later is reasonable if there is worry.

Supporting someone well

Treat sudden severe testicular pain as torsion and go straight to A and E.

For gradual onset, get seen the same day and expect tests for both sexually transmitted and urinary causes.

Take the full antibiotic course, which may be two weeks or more.

Use scrotal support, rest, ice and anti-inflammatories in the first days.

Make sure partners are tested and treated where a sexually transmitted cause is found.

Expect several weeks of residual swelling, and get a persisting lump checked rather than assuming it is scarring.

In an older man, ask about the prostate and bladder emptying.

Keep MMR vaccination up to date to prevent mumps orchitis.

Where to get help

A and E for sudden severe pain; a GP or urgent care for gradual onset.

A sexual health clinic where a sexually transmitted cause is likely, which is faster and better equipped for testing.

Urology for recurrent episodes or chronic pain.

Terrence Higgins Trust for sexual health information.