Epididymitis symptoms

Common symptoms of epididymitis

The most typical symptom is pain and tenderness in one testicle or one side of the scrotum. CDC guidance says acute epididymitis typically presents with unilateral testicular pain and tenderness, along with swelling of the epididymis.

Other symptoms may include:

• swelling of the scrotum

• warmth or redness of the scrotal skin

• tenderness behind the testicle

• a feeling of heaviness

• fluid around the testicle

• burning or difficulty when urinating

• penile discharge

• fever or feeling unwell in some cases

The NHS also lists a tender, warm and swollen scrotum and fluid around the testicle as possible symptoms.

1. Testicular or scrotal pain

Pain is often the symptom that brings men to medical attention.

Epididymitis commonly causes pain on one side, although symptoms can affect both sides. The discomfort may begin gradually and become more noticeable over time.

The pain may be felt in the testicle, behind the testicle or throughout the scrotum.

Pain alone does not establish the diagnosis. Testicular torsion, injury, hernia, infection and other conditions can produce similar symptoms.

2. Swelling and tenderness

The affected side of the scrotum may become swollen and tender to touch.

The scrotal skin can also feel warmer than usual and may become red. The epididymis itself can become enlarged and painful.

Sometimes fluid collects around the testicle, producing a swelling called a hydrocele.

3. Burning or painful urination

Some men with epididymitis experience burning or discomfort when passing urine.

This can be particularly relevant when the inflammation is associated with an infection affecting the urethra.

However, burning urination has many causes, including urinary tract infections, urethritis and prostatitis. Doctar's prostatitis symptoms and treatment guide covers another common source of urinary and pelvic symptoms.

4. Penile discharge

White, yellow or green discharge from the penis can occur when epididymitis is associated with a sexually transmitted infection such as chlamydia or gonorrhea.

Not every man with STI-related epididymitis has discharge.

In fact, urethritis associated with STI-related epididymitis can sometimes be asymptomatic.

If discharge is present, STI testing is usually an important part of the evaluation.

See Doctar's guide to chlamydia and gonorrhea symptoms for more information.

5. Fever and feeling unwell

Some men develop fever or generally feel unwell, particularly when the underlying infection is more significant.

A high fever or severe illness alongside scrotal pain deserves prompt medical attention because it can indicate a complicated infection or another serious condition.

Not everyone with epididymitis develops fever.

What causes epididymitis?

The cause can differ between individuals.

In younger sexually active men, chlamydia and gonorrhea are important causes. In other men, epididymitis may be related to urinary bacteria, particularly when there are urinary-tract problems.

Other possible causes include:

• urinary tract infections

• urinary obstruction

• prostate problems

• recent urinary procedures or catheter use

• certain viral infections

• trauma

• less common inflammatory conditions

This is why a medical history and appropriate testing matter.

Is epididymitis an STI?

Sometimes, but not always.

Epididymitis itself is not an STI. However, sexually transmitted infections can cause it.

Chlamydia and gonorrhea are particularly important causes in sexually active younger men. In older men, urinary bacteria and urinary-tract problems may be more likely causes.

If an STI is suspected, the sexual partner or partners may also need testing and treatment.

Doctar's STI testing guide explains how testing is approached.

Epididymitis vs testicular torsion

This distinction can be critical.

Testicular torsion happens when the spermatic cord twists and cuts down the testicle's blood supply. It is a surgical emergency.

Epididymitis often develops more gradually, whereas torsion can cause sudden, severe pain. But symptoms can overlap, so the distinction cannot safely be made at home.

Seek urgent medical care if:

• testicular pain starts suddenly

• the pain is severe or unbearable

• the pain continues while resting

• severe pain is accompanied by nausea or vomiting

• there is sudden swelling of the scrotum

The NHS specifically advises emergency assessment for sudden, severe testicular pain.

Do not wait for a routine STI appointment if the pain is sudden and severe.

Can epididymitis cause a testicular lump?

Inflammation and swelling can make the epididymis feel enlarged, and fluid around the testicle can create a lump-like swelling.

But a new testicular lump should not automatically be labelled epididymitis.

Testicular cancer is another possible cause of a lump or change in the testicle. Most testicular lumps are not cancer, but they should still be examined.

Doctar's testicular cancer self-exam guide explains what changes men should be aware of.

How is epididymitis diagnosed?

A doctor usually begins with a physical examination and medical history.

Depending on the suspected cause, tests may include:

• urine testing

• STI testing for chlamydia and gonorrhea

• blood tests

• a urethral swab in selected situations

• examination of the groin and scrotum

• ultrasound when needed

CDC guidance recommends testing men with suspected acute epididymitis for chlamydia and gonorrhea using a nucleic acid amplification test (NAAT).

Ultrasound is particularly useful when testicular torsion needs to be considered.

Can epididymitis affect fertility?

Severe or untreated infections can sometimes cause complications affecting the reproductive system.

The epididymis is involved in sperm transport, so inflammation can potentially affect reproductive function, particularly when infection is severe, recurrent or complicated.

This does not mean that every man with epididymitis will develop fertility problems.

If conception is difficult, a proper fertility evaluation is more useful than assuming epididymitis is responsible. Doctar's male fertility testing guide explains the standard evaluation.

How is epididymitis treated?

Treatment depends on the underlying cause.

When bacteria are responsible, antibiotics may be required, with the specific treatment determined by the suspected organism and clinical circumstances. The NHS notes that epididymitis is usually treated with antibiotics when infection is the cause.

A doctor may also recommend supportive measures to reduce discomfort and swelling.

Do not take leftover antibiotics or choose an antibiotic based only on an online symptom list. The wrong treatment can delay recovery and may not address the actual cause.

How long does epididymitis take to improve?

Symptoms can start improving after appropriate treatment, but complete recovery may take considerably longer.

The NHS notes that men may begin to feel better within a few days, while full recovery can sometimes take up to three months.

Persistent discomfort does not necessarily mean that an infection is still active, but it does warrant follow-up when symptoms fail to improve as expected.

Can epididymitis come back?

Yes.

Recurrence can occur, particularly when an underlying urinary problem or another contributing factor has not been addressed.

Repeated or persistent scrotal pain may also have causes other than active infection. Chronic epididymitis is generally defined as symptoms lasting at least six weeks, and the differential diagnosis includes trauma, cancer, autoimmune conditions and other causes.

A urologist may be appropriate when symptoms persist or repeatedly return.

What should men do if an STI is suspected?

If chlamydia or gonorrhea may be responsible, sexual-health testing is important.

Avoid sexual activity until you have received appropriate medical advice and, when an STI is confirmed, followed the recommended treatment and partner-management instructions.

Partners may need testing or treatment to prevent reinfection and further transmission.

Doctar's STI prevention guide provides practical prevention information.

In clinical practice, men sometimes assume that scrotal pain is simply a pulled muscle or minor injury. That can be a costly assumption when the real problem is an infection or, more urgently, testicular torsion. The timing and severity of the pain matter.

When should you see a doctor?

Arrange prompt medical assessment for:

• testicular or scrotal swelling

• persistent testicular pain

• tenderness behind the testicle

• penile discharge

• painful urination

• fever with scrotal symptoms

• a new lump or change in the testicle

• symptoms following a possible STI exposure

For sudden, severe testicular pain, seek emergency medical care immediately.

Practical takeaway

The classic symptoms of epididymitis are pain, tenderness and swelling, usually affecting one side of the scrotum. Urinary burning and penile discharge may occur when an STI or urinary infection is responsible.

But sudden severe testicular pain is different. Because testicular torsion is an emergency, don't try to distinguish it from epididymitis at home.