Understanding Epididymitis: Symptoms, Causes, and Treatment in the UK

Epididymitis is a medical condition characterised by the inflammation of the epididymis—a coiled tube located at the back of each testicle that stores and carries sperm. When this tube becomes irritated or infected, it can result in significant pain and swelling within the scrotum.

In the UK, epididymitis is a relatively common presentation in primary care. While it can affect males of any age, it is most frequently diagnosed in those aged 19 to 35. If the inflammation also spreads to the testicle itself, the condition is referred to as epididymo-orchitis. Understanding the underlying cause is essential, as treatment varies depending on whether the trigger is an infection or physical trauma.

The symptoms of epididymitis usually develop gradually over one or two days. Unlike certain other scrotal conditions, the discomfort often begins as a dull ache before progressing to more acute pain. Common signs to look out for include:

• A swollen, red, or warm scrotum.
• Tenderness or pain, usually on one side of the scrotum.
• A heavy sensation in the testicle area.
• Pain or a burning sensation during urination (dysuria).
• An urgent or frequent need to urinate.
• Discharge from the penis.
• Pain or discomfort in the lower abdomen or pelvic area.

In some cases, you may also experience a fever or chills, which suggests an active infection that requires prompt medical review.

The causes of epididymitis are generally categorised by the age of the patient and their sexual history, aligning with NICE (National Institute for Health and Care Excellence) guidelines. The most frequent causes include:

1. Sexually Transmitted Infections (STIs)

In younger, sexually active men, the most common cause is an STI, such as chlamydia or gonorrhoea. These bacteria travel from the urethra through the spermatic cords to the epididymis.

2. Urinary Tract Infections (UTIs)

In older men or those with enlarged prostates, epididymitis is often caused by common urinary bacteria, such as E. coli. This can happen if bacteria from a bladder or prostate infection tracks back to the scrotum.

3. Other Causes

Less commonly, the condition can be caused by a viral infection (like the mumps virus), a direct injury to the groin, or even a side effect of certain medications such as amiodarone. In some instances, 'chemical epididymitis' occurs when urine flows backward into the epididymis, often due to heavy lifting or strenuous exercise with a full bladder.

To diagnose epididymitis, a healthcare professional will first conduct a physical examination of the scrotum to check for swelling, tenderness, and enlarged lymph nodes in the groin. Following this, several tests may be required:

• Urine Test: To check for signs of a bacterial infection or UTI.
• STI Screening: A swab of the urethra or a specific urine test for chlamydia and gonorrhoea.
• Ultrasound Scan: This is often used to rule out testicular torsion (a surgical emergency) and to check for abscesses or issues with blood flow.

It is important to be honest with your clinician about your sexual history, as this directly informs which antibiotic treatment will be most effective for you.

The primary treatment for infectious epididymitis is a course of antibiotics. If your doctor suspects an STI, you may be given an initial injection of antibiotics followed by a 10 to 14-day course of tablets. It is vital to finish the entire course, even if your symptoms improve before the medicine is gone.

To manage pain at home, you can:

• Rest and avoid strenuous activity.
• Use over-the-counter pain relief such as paracetamol or ibuprofen (consult a pharmacist first).
• Wear supportive underwear (such as briefs rather than boxers) to cradle the scrotum and reduce discomfort.
• Apply cold compresses to the area for short periods.

If the cause is an STI, any sexual partners from the last 60 days should also be tested and treated to prevent reinfection and further spread.

You should consult a GP—whether in person or via an online video consultation—as soon as you notice swelling or persistent pain in the scrotum. Early intervention is key to preventing complications such as chronic pain or fertility issues.

An online GP can assess your symptoms, provide advice on pain management, and, if appropriate based on clinical assessment, issue a prescription for antibiotics or a referral for further testing. However, if your pain is sudden, debilitating, and accompanied by nausea, you must seek immediate emergency care at an A&E department, as this could indicate testicular torsion, which requires surgery within hours to save the testicle.