[Question #4447] Epididymitis

27 months ago
A month ago I started feeling pain in my right testicle. I went to an urgent care clinic as I don't have insurance and don't have a pcp. They tested me for chlymidia and gonnoreha which both came back negative. Two days later I went to a different urgent care and they diagnosed me with epididymitis. I was prescribed two weeks of levofloxacin and the pain mostly went away after about 3-4 days. After 2 weeks of levofloxacin I went back for a follow up and told them my pain level was 0/1 out of 10 as I was still feeling a dull pain once in a while when I was at work and lifting and stretching. Also the redness of the scrotum was still present. 
Wasn't able to follow up with the same doctor so the new doctor did an exam and squeezed each of my testicle and I said "owe" of course. So he prescribed me another month on Cipro. 
My questions are for me and my girlfriend because it's making things difficult in our relationship at the moment.
Is there any other stds that can cause epididymitis?
Do symptoms like the dull once in a while pain and redness of scrotum usually continue for a while after treatment?
Should we feel safe having sex again, that I am not going to pass anything to her or give her a uti from whatever caused this?





27 months ago
Also want to mention that I have no reason to think it's std related but the fact that I keep seeing that the most common cause is stds, it scares me.. and after reading that so much it was hard to tell my girlfriend about knowing that she'd worry.  I only had the pain and redness and sometimes slight lower abdominal pain which I also still get, again mostly when I'm doing physical work. Never had any discharge or painful urination.. 
Really confused as to why this is happening and what could have caused it..
I have been referred to a urologist which I am hoping will give me some answers but not able to see them until the end of next month.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
Welcome back to the forum, but sorry you found it necessary.

I'll be taking this question, but I reviewed your discussion a month ago with Dr. Hook. I'm slightly confused in looking at it. You mentioned E. coli in your original quesiton, and I think Dr. Hook assumed you ahd been tested for it and that was the cause. But that is never explicitly stated, and I'm not convinced you ever had epididymitis, even though an urgent care doctor made that diagnosis. But even if you did, I'm confident it's now gone. It is entirely natural for mild discomfort to persist weeks or even months after cure. That's true for any injury of any body part, whether the injury is due to infection, trauma, or anything else. Just think of the sprained ankle that still aches long after healing is complete. Why should it be any different for the testicels?

In any case, I see no reason that this problem should be affecting your relationship. If you had epididymitis, it wasn't due to any STD. (And no, there are no STDs other than gonorrhea or chlamydia known to cause epididymitis. And as Dr. Hook said, if you had epididymitis due to E. coli or another enteric (intestinal) bacteria, it would be harmless to your partner and not a reason to avoid sex. Frankly, I would have encouraged you to never stop having sex with your parnter, once it was known your gonorrhea and chlamydia tests were negative.

It is true that in men under age 30-35, most epidydymitis is due to STDs -- but only gonorrhea and chlamydia. In older men, E. coli and other enteric bacteria usually are responsible. But there are exceptions both ways:  younger men with enteric bacteria, older ones with gonorrhea or chlamydia. in any case, absnce of discharge and painful urination are against all of these. Also, get used to the strong probability that you're never going to have better answers than you have now:  you're not likely to ever know a specific cause of the problem. But this sort of thing doesn't cause any long term complications or serious outcomes, so at this point it really shouldn't matter very much.

Going forward, I suggest two things:  First, resume sex with your regular parnter. No harm will come either to you or her. Second, hold off a while on seeing the urologist. Almost certainly you just have residual pain that doesn't mean anything important, and my bet is that it will gradually resolve as the next weeks and months go by. I very much doubt a urological evaluatoin witll find anything significant. These things are what I would advise my own patients, and also what I would do if I were in your stiuation.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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27 months ago
Thank you, no I was never tested for e. Coli or other bacteria. When I went to the second urgent care they had prescribed me docsacilin and after reading further into it I realized that was mostly for chlymidia and gonnoreha infections so I called them back and asked if that would be the right choice of antibiotic if it were actually caused by e. Coli or other bacteria since I knew it wasn't caused by the first two and they had me come back in and gave me a shot and switched me to levafloxacin..  The only urine test done was for chlymidia and gonnoreha even though I told them that wasn't a concern. Kind of upset that they didn't do further testing and that now I am on another month of antibiotics as they are I believe keeping me from getting the rest I need. Could also be that I'm just stressing out about it. They never did an ultrasound or blood draw either. Really dissapointed after going for my follow up and feeling rushed and pushed out of there with them just throwing me on more antibiotics. Would you advise to go back and ask for those tests to be done? Or should I just finish this month of antibiotics and hope it doesn't come back when I'm finished?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
27 months ago
Whatever you had, epidymitis or not, it's getting better and I would recommend against any additional tests or evaluatoin of any kind. Maybe if pain is continuing after another month or two, but not now. As for "Could also be that I'm just stressing out about it":  I agree that almost certainly your concerns are making you more sensitive and aware of the apparently minor ongoing discomfort you have. I also see no reason for you to still be taking antibiotics; epididymitis rarely if ever needs more thann 2 weeks treatment, and I'm pretty sure your current discomfort is not because of persisting infection. And by the way, although doxycycline indeed is recommended for chlamydial epididymitis (but not cases due to gonorrhea), it also is highly effective against almost all the non-STD bacteria that cause it.

In the event your doctor suspects you in fact had prostatitis and not epididymitis (it can cause referred pain into a testicle), then 6 weeks total antibioitc treatment may be warranted. But based on what I know, I see no need for it. 
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