STD: TESTING FOR EPIDIDYMITIS AND PROSTATITIS EPIDIDYMITIS
The diagnosis of epididymitis is made on examination. A red, swollen, tender testicle on only one side is suggestive of the disorder. An evaluation is usually carried out for urethritis and a bladder infection.
For a urethritis screening test, a man should not have voided for at least four hours prior to the examination. A small swab is inserted a short distance into the urethra, and then material from the swab is examined under the microscope for causative bacteria. (See the section on nongonococcal urethritis for more information about these screening procedures.)
Tests for gonorrhea and chlamydia are usually performed, and a midstream urine sample is obtained for analysis under the microscope and culturing. Both the screen for urethritis and the screen for a UTI are important in helping to sort out the cause of the epididymitis.
Other medical conditions can cause testicular pain and swelling. Torsion of the testicle is a medical emergency that occurs when the spermatic cord and blood vessels that lead to a testicle become twisted and cut off the blood supply to the testicle. This condition can lead to the death of the testicle if not quickly corrected surgically. It usually occurs on only one side, so it can be difficult to distinguish from epididymitis. However, torsion of the testicle usually occurs in young men and has a very sudden onset of symptoms, and there usually is no evidence of urethral infection on examination. Epididymitis typically has a more gradual onset of symptoms, but there are exceptions.
If there is difficulty distinguishing between epididymitis and torsion of the testicle, a study such as a Doppler-ultrasound can be performed to help make the diagnosis. This test measures blood flow to the testicle and, by bouncing sound waves off the internal structures of the scrotum, allows them to be visualized.
Other testicular problems that can be confused with epididymitis are trauma to the testicle (usually a man will know that this has occurred), testicular cancer, and other infections of the testicle such as tuberculosis, which is rare. An experienced health care provider can sort out these possibilities and order appropriate tests to make the diagnosis. For complicated situations, such as failure of the epididymitis to respond to antibiotic treatment, a urologist should be consulted for further evaluation and treatment.
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