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Introduction

Acute epididymitis is a common cause of acute scrotal pain characterized by inflammation of the epididymis, the tubular structure located on the posterior aspect of each testicle ( Figure 1).  Acute epididymitis is most often caused by bacterial organisms that ascend from the urethra; the identity of the pathogen varies by patient age.  Typical clinical findings include the gradual onset of unilateral testicular pain and swelling and epididymal tenderness on examination.  Broad-spectrum antibiotics are the mainstay of treatment.

Pathophysiology

Most cases of epididymitis occur when genitourinary pathogens travel in a retrograde fashion from the urethra to the vas deferens and into the epididymis.  The most likely bacterial organisms vary by patient age and risk factors.

  • Men age <35:  Most cases of epididymitis are caused by sexually transmitted infections, specifically

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