Epididymitis: Symptoms, Differential Diagnosis & When to Seek Care

Typical Symptoms

• Unilateral scrotal/testicular pain (gradual onset, hours–days)
• Swelling, tenderness, erythema, warmth
• Hydrocele (reactive fluid)
• Dysuria, urinary frequency/urgency
• Urethral discharge (if STI-related)
• Fever, chills (systemic signs)
• Painful ejaculation

Key Differential: Testicular Torsion (EMERGENCY)

• Sudden, severe pain; high-riding testis; absent cremasteric reflex; nausea/vomiting.
• Time-critical: Detorsion within 6 hrs for salvage.
• Doppler US confirms flow.

Etiology by Age/Sexual Activity

• <35, sexually active: C. trachomatis, N. gonorrhoeae (STI).
• >35 or insertive anal sex: Enteric flora (E. coli, Pseudomonas).
• Prepubertal/older men: Urinary reflux, anatomic anomalies, instrumentation.
• Viral: Mumps (orchitis-epididymitis).
• Drug-induced: Amiodarone.

Management

• Antibiotics targeting likely pathogen (ceftriaxone + doxycycline for STI; fluoroquinolone for enteric).
• Scrotal elevation, NSAIDs, rest.
• Partner treatment for STI.
• Follow-up to ensure resolution; rule out tumor if atypical.

Seek immediate care for acute scrotal pain—torsion cannot be excluded clinically.