Acute epididymitis is an inflammation of the epididymis. Chronic epididymitis refers to epididymal pain and inflammation (usually without scrotal swelling) that lasts for more than 6 months. Epididymitis and epididymo-orchitis are usually caused by a bacterial infection.Organisms may reach the epididymis by retrograde spread from the prostatic urethra and seminal vesicles or less commonly, through the blood stream. E. coli and Chlamydia in patients with a history of urethral discharge are the organisms most frequently cultured.Clinically, epididymitis may be indistinguishable from testicular torsion. Epididymo-orchitis denotes secondary involvement of the testis. Symptoms of epididymitis and epididymo-orchitis include swelling and tenderness of the infected area, pain that may become constant and severe, fluid around the testes (hydrocele), and sometimes a fever. Epididymitis and epididymo-orchitis are usually treated with antibiotics taken by mouth, bed rest, pain relievers, and ice packs applied to the scrotum. Abscesses tend to drain on their own, but occasionally surgical drainage is necessary.

Causes of Epididymo Orchitis

The common Causes of Epididymo Orchitis :

In men younger than 35 years of age epididymo-orchitis is most often caused by sexually transmitted pathogens such as Chlamydia trachomatis and Neisseria gonorrhoeae
Gram-negative enteric organisms are more commonly the cause of epididymo-orchitis if recent instrumentation or catheterisation has occurred.
Men with Behcet's disease may get a non-infective epididymo-orchitis.
Trauma to the scrotum can be a precipitating event.
Other rare infections (e.g. brucellosis , coccidioidomycosis, blastomycosis, cytomegalovirus and candidiasis usually occur in immunocompromised hosts.
Obstruction: Adults older than 40 years usually have a bladder outlet obstruction, (e.g. benign prostatic hyperplasia or urethral stricture; children may have various congenital abnormalities or functional voiding problems.

Symptoms of Epididymo Orchitis

Some Epididymo Orchitis :

Scrotal swelling .
Testicle pain aggravated by bowel movement or straining .
Pain with intercourse or ejaculation.
Fever.
Pain with urination (dysuria).
Discharge from penis .
Groin pain .
Tender, swollen groin area on affected side .
Blood in the semen .

Treatment of Epididymo Orchitis

Antibiotics used for sexually transmitted pathogens may need to be varied according to local knowledge of antibiotic sensitivities.
Empirical therapy should be given to all patients with epididymo-orchitis before culture results are available. The antibiotic regimen chosen should be determined in light of the immediate tests as well as age, sexual history, any recent instrumentation or catheterisation, and any known urinary tract abnormalities in the patient.
Follow-up and differential diagnosis as needed.
Epidemiological treatment of sexual partners.
Empirical therapy, including bed rest, scrotal elevation and support, analgesics, and non-steroidal anti-inflammatory drugs.
Screening for other sexually transmitted infections in men who have epididymo-orchitis caused by a sexually transmitted infection.

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