Epididymitis is an infection of the epididymis, which usually spreads from an infected urethra, bladder, or prostate. The incidence is less than 1 in 1,000 males per year; prevalence is greatest in men 19 to 35 years of age. Risk factors include recent surgery or instrumentation of the urinary tract, high-risk sexual activities, personal history of sexually transmitted infections (STIs), past prostate infections or urinary tract infections (UTIs), lack of circumcision, history of an enlarged prostate, and the presence of a chronic indwelling urinary catheter.

In prepubertal males, older men, and homosexual men, the predominant causal organism is Escherichia coli, although in older men the condition may also be a result of urinary obstruction. In sexually active men ages 35 years and younger, the pathogens are usually related to bacteria associated with STIs (e.g., Chlamydia trachomatis, Neisseria gonorrhoeae). The infection moves in an upward direction, through the urethra and the ejaculatory duct, and then along the vas deferens to the epididymis.

• Often slowly develops over 1 to 2 days, beginning with a low-grade fever, chills, and heaviness in the affected testicle
• Unilateral pain and soreness in the inguinal canal along the course of the vas deferens.
• Pain and swelling in the scrotum and groin
• Possible discharge from the urethra, blood in the semen, pus (pyuria) and bacteria (bacteriuria) in the urine, and pain during intercourse and ejaculation
• Urinary frequency, urgency, or dysuria, and testicular pain aggravated by bowel movement

• Urinalysis, Gram stain of urethral drainage, urethral culture or DNA probe
• Complete blood count
• Referral for STI testing in sexually active patients (syphilis, chlamydia, gonorrhea, and HIV)

If epididymitis is associated with an STI, the patient's partner should also receive antimicrobial therapy; selection of antibiotic depends on culture results. Patient's spermatic cord may be infiltrated with a local anesthetic agent for analgesia if patient is seen within the first 24 hours after onset of pain. Urethral instrumentation is avoided. Chronic epididymitis requires a 4 to 6 week course of antibiotics; infertility may result from inability of sperm to pass through the obstructed epididymis. Epididymectomy (excision of the epididymis from the testes) may be performed for patients who have recurrent, refractory, incapacitating episodes of this infection.

• Place patient on bed rest with scrotum elevated with a scrotal bridge or folded towel to prevent traction on spermatic cord, to improve venous drainage, and to relieve pain.
• Give antimicrobial medications as prescribed.
• Provide intermittent cold compresses to scrotum to help ease pain; later, local heat or sitz baths may hasten resolution of inflammatory process.
• Give analgesic agents as prescribed for pain relief.
• Instruct patient to avoid straining, lifting, and sexual stimulation until infection is under control.
• Instruct patient to continue with analgesic and antibiotic medications as prescribed and to use ice packs as necessary for discomfort.
• Explain that it may take 4 weeks or longer for the epididymis to return to normal.

For more information, see Chapter 59 in Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth's textbook of medical-surgical nursing (14th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.