[Question #9590] Epididymitis, possible causes and partner management

31 months ago

Hello Doctors,

I used this service in the past with great satisfaction and I am back with a new exposure and questions.

A month ago at my work's Christmas party I (36yo male) hooked up with a coworker (34yo female) and we engaged in protected vaginal sex and unprotected oral sex.

She is low risk on paper (HR professional who lives with her parents) but travels a lot for work so I wouldn't be shocked if she had several sexual partners over the past 12-18 months).

Following the encounter I had no symptoms whatsoever, but 25 days after I noticed my right testicle was swollen an painful to the touch (no pain if I did not touch it).

Went to the doctor and he quickly diagnosed epididymitis. Prescribed Ciprofloxacin for 2 weeks.

After 4 days of antibiotics the epididymitis is almost gone.

Having a long term partner, I am obviously concerned about gonorrhea and chlamydia.

1. In terms of timeline, is it common to develop epididymitis a month after potentially contracting one of these STDs?

2. In absence of symptoms, how likely is it that the epididymitis was caused by gonorrhea or chlamydia?

3. Is the fact that Cipro worked evidence against gonorrhea or chlamydia (given that it is ineffective against them)? Or would Cipro have cured the epididymitis even if it was caused by gono/chlam?

4. Is it safe to resume sex with my regular partner right away, or should I wait until the end of the Cipro (currently day 5 out of 10)?

Thank you

Edward W. Hook M.D.

31 months ago

Welcome to the Forum and thanks for your questions. I'll be glad to comment. Your symptoms certainly sound like epididymitis. Did your doctor do any tests, either for regular bacteria using a urine culture or for gonorrhea or chlamydia (which can also be performed on urine but are different tests than for usual UTI bacteria). The reason I ask is that epididymitis could be caused either by STI pathogens (gonorrhea or more likely, chlamydia) or UTI pathogens. In addition, ciprofloxacin is not the preferred therapy for either gonorrhea or chlamydial infections. Before I make a final comment, let me address your specific questions:

1. In terms of timeline, is it common to develop epididymitis a month after potentially contracting one of these STDs?

STI-related epididymitis could certainly occur in this time frame but it could well be coincidental as well. The encounter you describe was low risk for gonorrhea and very, very low risk for chlamydia. Had you acquired gonorrhea from the encounter you describe, I would have expected you to have a purulent penile discharge. OTOH, chlamydia is much less likely but could be asymptomatic until your symptoms began.

2. In absence of symptoms, how likely is it that the epididymitis was caused by gonorrhea or chlamydia?

See above.

3. Is the fact that Cipro worked evidence against gonorrhea or chlamydia (given that it is ineffective against them)? Or would Cipro have cured the epididymitis even if it was caused by gono/chlam?

Unfortunately ciprofloxacin can resolve symptoms but not entirely cure the infection.

4. Is it safe to resume sex with my regular partner right away, or should I wait until the end of the Cipro (currently day 5 out of 10)?

My advice is that if you have not been tested, you should have been. If you do not have test results available, out of an abundance of caution I would suggest testing for gonorrhea and chlamydia and to hold off until you have test results and have completed your course of therapy.

I hope this information is helpful. You need test results of some sort. EWH

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31 months ago

Hello Dr. Hook,

Thank you for your answers.

The doctor that visited me did not perform any tests, he just touched and applied pressure to my testicles and told me it was epididymitis.

I will follow your advice and get tested as soon as possible. In the meantime I have a couple of follow up questions:

1. If I get tested now, will ciprofloxacin affect my results? Or should I wait until I am done with the antibiotics?

2. In percentage, how often have you seen in your practice epididymitis caused by UTI instead of gonorrhea/chlamydia?

3. Is there any difference in the severity or pain level of epididymitis caused by STDs vs epididymitis caused by UTI or other pathogens? I am asking because my epididymitis was "mild" and I had no pain at all unless pressure was applied on the testicle.

4. You mentioned that ciprofloxacin is not the preferred treatment for gono/chlam. Do you know if it has at least a beneficial effect (weakening the STD but not eradicating it) or if it's completely ineffective?

Thanks again for your help.

Edward W. Hook M.D.

31 months ago

Straight to your questions:

1. If I get tested now, will ciprofloxacin affect my results? Or should I wait until I am done with the antibiotics?

Waiting until more than 5 days after completion of antibiotics will give you a better answer as to your infection status. If negative, you may have been infected and cured or you may never have been infected

2. In percentage, how often have you seen in your practice epididymitis caused by UTI instead of gonorrhea/chlamydia?

With increasing age the likelihood that epididymitis is due to a UTI increases. You are in a borderline age group. I would also point out however that the exposure you describe was low risk (one other way of addressing this issue is to mention to your causal partner that you developed epididymitis which is sometimes due to an STI and that it might be in her best interest to be checked. if negative, that also indicates that your infection was likely to be due to UTI)

In persons with gonorrhea or chlamydia cipro can improve symptoms without curing the infection (I said this above)

EWH

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31 months ago

Thanks Dr. Hook.

Final follow up: I had a vasectomy 12 months ago. Is there a relationship between epididymitis and vasectomy? Would it increase the risk of epi or perhaps reduce it (since it eliminates the chance of bacteria going down into the testicles)?

Thank you for all your answers and take care!

Edward W. Hook M.D.

29 months ago

Epididymiitis can be a complication of vasectomy but it would typically occur soon after the procedure. If anything it would reduce risk for infection.

This completes this thread. Sorry for the delay in responding. EWH

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