Epididymitis is inflammation of the epididymis, the coiled tube at the back of each testicle that stores and carries sperm. Bacteria cause most cases, so antibiotics are the treatment. Most people feel better about three days after starting them, though swelling can take weeks to settle (Cleveland Clinic: Epididymitis). The condition to rule out first is testicular torsion, a twisted testicle. Sudden, severe testicle pain is an emergency, so go to an emergency room instead of waiting to see which it is.
The short version
- Epididymitis is most common between ages 14 and 35, with about 600,000 US cases a year (Cleveland Clinic).
- Under 35, the cause is usually an STI such as chlamydia or gonorrhea. Over 35, it is usually bacteria from a urinary infection.
- Antibiotics treat bacterial cases. Pain eases within days, swelling can take weeks, and some discomfort can last for months.
- If an STI caused it, recent sex partners need testing and treatment too.
- Sudden, severe testicle pain can be torsion, an emergency.
What is epididymitis?
The epididymis is a tightly coiled tube that runs along the back of the testicle (see what is the epididymis?). Epididymitis means that tube is inflamed, which causes discomfort or pain in the scrotum, the testicle or the epididymis itself (Cleveland Clinic: Epididymitis).
The CDC defines acute epididymitis as lasting under six weeks and chronic epididymitis as symptoms for six weeks or more (CDC: STI Treatment Guidelines, Epididymitis). When the testicle is inflamed as well, the term is epididymo-orchitis.
What are the symptoms of epididymitis?
The pain can be sudden or gradual, in one testicle or both, and the scrotum can feel tender, warm and swollen (NHS: Epididymitis). Cleveland Clinic and MedlinePlus add fever and chills, a feeling of heaviness, pain or burning when you pee and blood in the semen (MedlinePlus: Epididymitis). The NHS also lists penile discharge and a lump near the testicle.
What causes epididymitis?
Bacterial infection is the most common cause of acute epididymitis, and which bacteria depends largely on age and sexual activity.
| Who | Likely cause |
|---|---|
| Sexually active men under 35 | Chlamydia or gonorrhea |
| Men over 35 | Bacteria from a urinary infection, most often E. coli |
| Men who have sex with men | Intestinal bacteria such as E. coli add to the risk |
Cleveland Clinic and the NHS both give the under-35 and over-35 split, and MedlinePlus says E. coli and similar bacteria are also the more common cause in children. Cleveland Clinic says epididymitis is not itself classed as an STI, but chlamydia and gonorrhea are common triggers.
A urinary infection is more likely with an enlarged prostate, a urinary catheter or recent surgery on the groin, prostate or bladder. Less common causes include mumps, tuberculosis, a groin injury and amiodarone, a heart rhythm drug (NHS).
How is epididymitis diagnosed?
A clinician examines the scrotum and may order a urine test, a blood test, a urethral swab for STIs and sometimes a scrotal ultrasound (Cleveland Clinic: Epididymitis). Results take time, so treatment often starts first. The CDC says the starting antibiotic is chosen by the likely cause, then adjusted to the culture results.
How is epididymitis treated?
Antibiotics treat bacterial epididymitis, and most people take them for about one to two weeks. Finish the whole course even if you feel better, because stopping early can let it come back harder to treat. Bacterial epididymitis does not go away on its own, so this is not one to wait out at home (Cleveland Clinic).
If an STI is the cause, your partners need care too. The CDC says partners from the 60 days before your symptoms began should be evaluated, tested and treated, and that you and your partners should avoid sex until everyone is treated. The NHS says that with gonorrhea or chlamydia you should not have sex until you’ve finished the full course of treatment, or for 7 days after.
How long does epididymitis last?
Discomfort can continue for weeks or even months after the last dose, according to Cleveland Clinic. The NHS puts full recovery at up to 3 months and says you might be referred for further tests if symptoms are still there after that.
| When | What is typical |
|---|---|
| First 3 days | Pain starts to ease. If it hasn’t, go back to your clinician. |
| First 1 to 2 weeks | The usual length of an antibiotic course. |
| Several weeks | Swelling can take this long to improve, even after the last dose. |
| Up to 3 months | The NHS’s upper limit for full recovery. |
The CDC adds that symptoms not improving within three days mean the diagnosis and antibiotic need another look, and swelling that lasts after antibiotics should be checked for other causes, including a tumor or an abscess.
How do you tell epididymitis from testicular torsion?
You can’t reliably tell at home, and the worry is reasonable. In torsion, the spermatic cord twists and cuts off blood flow to the testicle. The main symptom is sudden, severe pain that can come with nausea, stomach pain, swelling and a testicle that sits higher than the other (Cleveland Clinic: Testicular torsion). Epididymitis can look much the same. MedlinePlus says the symptoms may be similar, the NHS says epididymitis pain can start suddenly, and fever is on both lists. That is why the CDC tells clinicians to consider torsion in every case and to send sudden or severe one-sided pain to a urologist urgently.
Timing matters. Almost everyone keeps the testicle if treatment comes within four to six hours, around half after 12 hours and roughly 1 in 10 after 24 hours (Cleveland Clinic). Resting or icing will not untwist it, and only a clinician can sort it out, usually with an exam and an ultrasound. If the pain came on suddenly and is severe, treat it as torsion until a doctor says otherwise.
What helps at home while the antibiotics work?
Home care eases symptoms but does not replace antibiotics:
- Rest lying down with the scrotum raised, for example on a rolled towel (MedlinePlus: Testicle pain). The CDC also lists bed rest and scrotal elevation.
- A cold pack on the groin, wrapped in a cloth or tea towel and never placed directly on the skin (NHS and MedlinePlus).
- Underwear that supports the scrotum, or an athletic supporter (NHS and MedlinePlus).
- An over-the-counter pain reliever, after checking with a clinician or pharmacist. The NHS notes that some antibiotics and anti-inflammatories don’t mix for people with a history of seizures.
Our scrotal support guide covers using support and ice together, including after hydrocele surgery and for a varicocele. Our recovery jockstrap keeps things from swinging and holds an ice pack in place, and the Nutsicle ice packs fit its pocket. Both were built for vasectomy recovery, not for epididymitis, so check with your clinician before using them for it.
Can epididymitis become chronic?
Yes. Cleveland Clinic describes chronic epididymitis as discomfort or pain lasting six weeks or longer that may come and go and is usually milder than the acute form. MedlinePlus says the condition may return. When no infection turns up, the CDC says the possible causes are wide, from injury and cancer to autoimmune conditions and cases with no clear cause.
A 2019 urology review notes that repeated antibiotic courses are rarely helpful for long-lasting scrotal pain and can delay the right treatment (Ziegelmann et al., Reviews in Urology, 2019). If you’ve finished two or three courses and the ache hasn’t moved, ask your clinician whether it’s time to look for another cause. Pain that lasts three months or more has its own workup: see our chronic testicle pain guide.
How is it different from congestive epididymitis after a vasectomy?
The two share a name and some symptoms. Epididymitis from infection needs antibiotics. Congestive epididymitis after a vasectomy is sterile inflammation from sperm backing up in the epididymis. Antibiotics are not the treatment, and it tends to show up gradually, weeks or months after the procedure.
If you’ve had a vasectomy, don’t assume a new ache is congestion. Fever, redness, swelling that keeps growing, burning when you pee or discharge are reasons to be seen right away. Pain that lasts past three months after a vasectomy has its own pages: post-vasectomy pain syndrome and how to find a specialist.
When should you call your doctor?
Go to an emergency room now for:
- Sudden, severe testicle pain, or testicle pain with nausea or vomiting.
- Pain or swelling that is still there an hour after an injury to the scrotum.
Both come from MedlinePlus: Testicle pain. The NHS adds that you shouldn’t drive yourself.
Call your doctor, or a sexual health clinic, for:
- Any symptoms of epididymitis, such as testicle pain and swelling with fever, burning when you pee or discharge.
- No improvement three days after starting antibiotics.
- Swelling or tenderness that lasts after the antibiotics are finished, or symptoms that return.
- A lump, a change in shape or one testicle getting bigger than the other. The NHS says lumps can be a sign of testicular cancer, which is easier to treat when found early.
If you need a urologist, the Undeez directory lists more than 14,000 across the US. Find a urologist near you.
FAQ
Is epididymitis an STI? Not by itself. Cleveland Clinic says providers don’t classify it as an STI, but chlamydia and gonorrhea are common causes under 35. In older men it is usually bacteria from a urinary infection.
How long does epididymitis take to go away? Most people feel better about three days after starting antibiotics. Swelling can take several weeks to improve, and the NHS says full recovery can take up to 3 months.
Can epididymitis go away on its own? Bacterial epididymitis does not, according to Cleveland Clinic, and most cases can’t be treated at home. Rest, support and cold packs ease symptoms while antibiotics work. See a clinician first, because torsion can look alike.
How do you tell epididymitis from testicular torsion? You can’t reliably tell by symptoms. Both can cause pain, swelling and fever, and epididymitis pain can start suddenly. Sudden, severe testicle pain is an emergency, and torsion needs surgery as soon as possible.
Can you have sex with epididymitis? Cleveland Clinic says not until a clinician says it’s okay. The CDC says that if an STI is the cause, you and your partners should avoid sex until everyone is treated.
Can epididymitis affect fertility? Rarely. MedlinePlus says most cases leave no long-term sexual or reproductive problems, though infertility is a listed complication. Cleveland Clinic says early treatment helps prevent complications.
Is epididymitis the same as congestive epididymitis after a vasectomy? No. Epididymitis is usually an infection that antibiotics treat. Congestive epididymitis is sterile inflammation from sperm backup after a vasectomy, and antibiotics don’t help.
Sources
- Cleveland Clinic: Epididymitis
- Cleveland Clinic: Testicular torsion
- NHS: Epididymitis
- MedlinePlus: Epididymitis
- MedlinePlus: Testicle pain
- CDC: STI Treatment Guidelines, Epididymitis
- Ziegelmann MJ, Farrell MR, Levine LA. Evaluation and management of chronic scrotal content pain. Reviews in Urology, 2019
Editorial and informational. Not medical advice. Read the full disclaimer.
