Red flag to remember
Report sudden severe pain, a high-riding testicle, or pain not relieved by scrotal elevation (possible torsion).
What is epididymitis?
In younger sexually active men it is usually from sexually transmitted organisms (chlamydia, gonorrhea); in older men it is more often from urinary tract bacteria (E. coli). It causes gradual scrotal pain and swelling and must be distinguished from testicular torsion.
Key points to remember
- Pain typically develops gradually (vs. the sudden onset of torsion) and is accompanied by scrotal swelling, redness, warmth, and often fever and dysuria.
- Elevating the scrotum tends to RELIEVE the pain (positive Prehn sign), and the cremasteric reflex is usually intact, helping differentiate it from torsion.
- Treatment is antibiotics targeting the likely organism, with NSAIDs, scrotal support, and rest.
- If STI-related, the patient's sexual partner(s) must also be treated and STIs reported as required.
- Pyuria and bacteriuria are often present, unlike in torsion.
- Complications include abscess, chronic epididymitis, and impaired fertility if untreated.
Common causes
- STI (young): chlamydia, gonorrhea
- E. coli (older/UTI source)
Signs & symptoms
- Gradual onset scrotal pain
- Fever, dysuria, discharge
- +Prehn's: pain ↓ when lifted
Nursing priorities
- Distinguish epididymitis from torsion; if onset is sudden and severe, treat as an emergency until torsion is excluded.
- Administer prescribed antibiotics and ensure completion of the full course.
- Promote comfort with scrotal elevation/support, ice, NSAIDs, and rest.
- Educate on STI prevention and partner treatment when applicable.
- Monitor temperature and assess for worsening swelling or abscess formation.
Labs & values
WBC:5,000-10,000/mm3 (may be elevated)
Urinalysis often shows pyuria and bacteriuria
STI testing (NAAT) positive for chlamydia/gonorrhea in younger men
Patient teaching
- Take the full course of antibiotics even after symptoms improve.
- Use scrotal support and ice, rest, and take NSAIDs for pain and inflammation.
- If sexually transmitted, ensure partners are treated and avoid intercourse until cleared.
- Return for sudden severe pain, high fever, or worsening swelling.
Red flags: report now
- Report sudden severe pain, a high-riding testicle, or pain not relieved by scrotal elevation (possible torsion).
- Report high fever, increasing swelling, or fluctuant mass suggesting abscess.
- Report failure to improve after starting antibiotics.
References
Clinical references for this topic
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