Epididymitis and orchitis – symptoms and when to urgently see a urologist

Content author: physician. Arthur Abbazov, urologist, andrologist · Editorial work: Editorial team of Wyspa Medycyny Przyjaznej · Medical review: lek. Arthur Abbazov · Date created: 07.08.2026 · Date reviewed: 07.08.2026 · Updated: 07.08.2026

This article is for educational purposes only and does not replace an urgent medical assessment. Sudden, severe testicular pain, pain with vomiting, a raised, rotated or transverse testicle, redness and swelling of the scrotum, fever with chills, pain after injury, and pain in a boy or teenager require immediate reporting to the emergency room or urology department - without making an appointment for the next day.

The most important information at a glance

• The epididymis is a structure adjacent to the testicle from behind, where sperm mature and are stored.
• Epididymitis is the most common cause of scrotal pain in adult men. When the process also affects the testicle, it is called epididymo-orchitis.
• Symptoms usually develop gradually over hours or days: pain, swelling, redness, tenderness, sometimes fever and urinary symptoms.
• In younger, sexually active men, sexually transmitted infections are a common cause. In older people - urinary tract bacteria.
• The most important diagnosis to exclude is testicular torsion. This is an emergency condition in which time is of the essence - the longer the ischemia lasts, the lower the chance of saving the testicle.
• Testicular torsion usually begins suddenly and violently, epididymitis progresses more slowly - but this rule has exceptions and does not replace examination.
• The basis of diagnosis is an interview, examination of the scrotum, urine examination and scrotal ultrasound with assessment of vascular flow.
• Treatment of inflammation is based on antibiotic therapy selected to the probable cause and symptomatic treatment.
• Untreated or poorly treated inflammation can lead to abscess, testicular infarction, chronic pain and affect fertility.
• In case of confirmed sexually transmitted disease, parallel treatment of the partner is necessary.

Find out more about the specialist

Doctor. Arthur Abbazov is a urologist and andrologist at Wyspa Medycyny Przyjaznej in Gdańsk. He deals with the diagnosis and treatment of diseases of the urogenital system in men, including inflammation of the scrotum, urinary tract infections and qualification for further urological diagnostics. He also conducts consultations in Russian.

Meet the doctor. Arthur Abbazova

When to go to the emergency room immediately - not to the clinic

Let's start from the end, because in the case of scrotal pain this is the most important information in the entire article. Do not make an appointment for the next day and do not wait until the morning if you have any of the following symptoms:

• pain in the testicle that came on suddenly and is severe,
• pain that woke you up at night,
• pain with nausea or vomiting,
• testicle raised higher than usual, positioned transversely or rotated,
• pain after scrotal injury, especially increasing pain,
• fever with chills and severe scrotal pain,
• redness with rapidly increasing swelling,
• scrotal pain with urinary retention,
• deterioration of general condition, weakness, confusion,
• any testicular pain in a boy or teenager.

There is one reason: testicular torsion. When torsion occurs, the blood supply is cut off and the testicular tissue does not tolerate it. The chance of saving the testicle is greatest in the first hours after the onset of pain and decreases with each subsequent hour. There is no way for the patient to distinguish volvulus from inflammation - an examination and ultrasound with flow assessment are needed.

The rule of thumb is simple: in case of sudden, severe pain in the testicle, we assume torsion until the doctor rules it out. It's better to travel unnecessarily than to lose a testicle.

What is the epididymis and what happens in it when it becomes inflamed?

The epididymis is an elongated structure attached to the testicle from behind and above. It can be felt as a soft lump running along the back of the testicle. Its role is to mature sperm produced in the testicle and store them until ejaculation.

Epididymitis most often develops via the ascending route - microorganisms penetrate from the urethra or bladder through the vas deferens to the epididymis. There is swelling, congestion and pain. If the process also affects the testicle, it is called epididymitis. Less often, inflammation affects only the testicle - this situation occurs, among others, with some viral infections.

It is worth knowing one symptom that we ask about in the office. In the initial phase of inflammation, the epididymis, i.e. the back part of the scrotum, is most painful, while the testicle itself remains less tender. Over time, the swelling increases and the boundaries become blurred - then the patient describes pain in the entire scrotum.

Epididymitis Symptoms

Symptoms usually worsen over hours or days. The most common include:

• pain in the scrotum on one side, initially in the back, worsening when touched,
• swelling and enlargement of the affected side,
• redness and warming of the skin of the scrotum,
• feeling of heaviness and pulling,
• pain radiating to the groin, lower abdomen or lumbar region,
• fever and chills,
• burning sensation when urinating, urinary frequency, urgency,
• discharge from the urethra,
• pain during ejaculation, sometimes blood in semen,
• intensification of symptoms when walking and exerting.

They don't have to all occur at once. In some men, pain without fever predominates, while in others the picture resembles a urinary tract infection accompanied by discomfort in the scrotum.

Epididymitis and testicular torsion - what the doctor is looking for

This is the most important differentiation in the urology of acute scrotum. The table below shows the features that weigh one way or the other. However, there is an important caveat: none of these features is conclusive, and exceptions to the rule occur so often that the decision is made based on the examination and ultrasound, never on the basis of the description of the symptoms.

In practice, this means one thing: the table is used to understand the problem, not to diagnose it yourself. If the pain appears suddenly and is severe, the treatment should be the same as for a sprain - immediate contact for emergency help.

Where does epididymitis come from?

The cause depends largely on the age and sexual activity of the patient - and this determines the selection of treatment.

Therefore, questions about sexual life, recent procedures and urinary system symptoms are not a doctor's curiosity, but a condition for selecting the appropriate treatment. The same clinical picture may require completely different antibiotics.

What is the diagnosis like?

The procedure has a fixed sequence, and its number one goal is to exclude testicular torsion.

• Interview. When and how did the pain start, did it increase or did it appear suddenly, was there any trauma, are there any urinary system symptoms, fever, urethral leakage, sexual activity, whether there have been any recent urological procedures.
• Scrotal examination. Assessment of the location of pain, swelling, position of the testicle, skin condition, presence of reflexes and inguinal lymph nodes.
• General urine test and culture. Searching for signs of infection and identifying the microorganism.
• Tests for sexually transmitted infections. In sexually active men, usually from material from the urethra or urine.
• Scrotal ultrasound with assessment of vascular flow. Key examination: allows you to assess the blood supply to the testicle, confirm inflammation, detect an abscess, hydrocele or nodular lesion.
• Blood tests. If a more severe course or complications are suspected.
• Assessment of the urinary system. In older men and in case of relapses - searching for the cause contributing to infection.

One practical note: proper flow in ultrasound reduces the likelihood of torsion, but in the case of a typical clinical picture of torsion, the doctor's assessment is decisive, not the imaging test itself. Therefore, ultrasound should not be treated as a final judgment in either direction.

Treatment

Treatment of epididymitis is based on antibiotic therapy selected to the most likely cause, determined on the basis of age, sexual history and test results. Therapy is usually started before obtaining the culture, and after receiving it, it is modified if necessary.

Complementary measures usually include:

• rest and limitation of physical activity,
• lifting the scrotum, for example by wearing tight supportive underwear,
• cool compresses in the first 24 hours,
• painkillers and anti-inflammatory drugs as recommended by the doctor,
• adequate hydration,
• refraining from intercourse until the end of treatment,
• parallel treatment partner with a sexually transmitted infection,
• a follow-up visit on the scheduled date.

Two things are particularly important here. Firstly, the antibiotic must be taken until the end, even if the pain subsides after a few days - premature discontinuation promotes relapses and becomes chronic. Second, the pain usually goes away faster than the swelling. A palpable thickening of the epididymis may persist for weeks and does not in itself indicate treatment failure.

If symptoms persist or worsen despite treatment, reassessment is necessary. This may indicate the wrong choice of antibiotic, a complication in the form of an abscess, or another cause of the condition.

Possible complications

If treated properly, epididymitis usually goes away without any lasting consequences. However, if neglected or recurrent, it may lead to:

• abscess in the scrotum, requiring surgical treatment,
• testicular infarction due to increased swelling and impaired blood supply,
• chronic pain in the scrotum,
• chronic inflammation of the epididymis with permanent thickening,
• obstruction of the vas deferens or epididymis, which may affect fertility,
• testicular atrophy,
• severe generalized infection.

The impact on fertility deserves a separate opinion, because patients rarely ask about it, and the topic is often important to them. The risk increases with bilateral inflammation, severe disease and mumps inflammation of the testicle. If a man is planning to have children, it is worth discussing this at a follow-up visit - sometimes it is justified to perform a semen analysis after treatment.

Testicular pain without fever - what other causes could it be?

Not all scrotal pain is inflammation. In the differential diagnosis, the doctor also takes into account:

• testicular torsion and testicular torsion,
• scrotal injury,
• inguinal hernia,
• testicular hydrocele and epididymal cyst,
• varicocele,
• ureteral stones with pain radiating to the scrotum,
• nodular lesion of the testicle,
• chronic scrotal pain syndrome.

Particular attention is paid to a painless, hard lump in the testicle. Such a lesion requires urological evaluation regardless of whether it is accompanied by pain - and often it is not. Feeling a lump does not mean the diagnosis of cancer, but always requires examination and ultrasound.

The most common myths

• "You can wait until the morning for testicular pain." No. In the case of sudden, severe pain, time is of the essence - testicular torsion leads to ischemia.
• "If there's no fever, it's nothing serious." No. Testicular torsion usually occurs without fever in the initial phase.
• "The kink only applies to teenagers." No. It is most common in boys and young men, but can occur at any age.
• "Inflammation always results from a sexually transmitted infection." No. Bacteria typical of urinary tract infections predominate in older men.
• "The antibiotic can be stopped when the pain stops." No. Discontinuation of therapy promotes relapses and transition into a chronic form.
• "Persistent thickening means the treatment has not worked." Not always. The swelling subsides slower than the pain and may last for weeks.
• "The partner does not need to be treated." NO. In case of sexually transmitted disease, treatment of the partner is necessary.
• "Inflammation always destroys fertility." No. If treated properly, it usually leaves no sequelae, but the risk increases when the disease is severe and bilateral.

Pain, swelling or redness in the scrotum?

If you experience sudden, severe testicular pain, go to the emergency department immediately. If the symptoms gradually increase, arrange an urgent urological consultation - we will determine the cause and select the treatment.

Diagnostics of scrotum diseases in the Island of Friendly Medicine in Gdańsk

In the Island of Friendly Medicine doctor. Arthur Abbazov consults men with ailments in the scrotum: pain, swelling, noticeable lumps and symptoms of urinary tract infections. The visit includes an interview, examination and planning of diagnostics appropriate to the clinical picture.

Scheduled consultation concerns gradually increasing ailments and follow-up after treatment. In the case of sudden, severe testicular pain, the right place is the emergency department or urology on-call service, where immediate diagnostics and surgical treatment are possible. The current scope of tests, doctor availability and prices must be confirmed during registration.

Find out more about the medicine. Arthur Abbazov Urology consultation Urology

What to ask a urologist?

• Has testicular torsion been ruled out for me?
• What is the most likely cause of my inflammation?
• Is testing for sexually transmitted infections necessary?
• Does my partner also require treatment?
• How long should I take the antibiotic and what should I do if there is no improvement?
• When can I return to physical activity and sexual intercourse?
• How long can thickening and swelling last?
• Is ultrasound control necessary after treatment?
• Can having inflammation affect my fertility?
• Should I check for an infection-promoting cause, such as prostate health?
• What to do if the symptoms return?
• What symptoms mean I need to come in immediately?

FAQ - Epididymitis

What is epididymitis?

This is an inflammation of the structure adjacent to the testicle from behind, where sperm mature and are stored. It most often develops through the ascending route, when microorganisms enter from the urethra or bladder.

What are the symptoms?

Most often, one-sided pain in the scrotum that increases over hours or days, swelling, redness and warmth of the skin, a feeling of heaviness, sometimes fever and urinary symptoms.

When does testicular pain require immediate help?

When it appears suddenly and is severe, when the patient wakes up at night, when accompanied by vomiting, when the testicle is elevated or transverse, after trauma, and with any testicle pain in a boy or teenager. These are situations that require a visit to the emergency department.

How to distinguish inflammation from testicular torsion?

This cannot be done reliably on your own. Torsion usually begins suddenly and inflammation builds up gradually, but exceptions are common. The decision is made by medical examination and ultrasound with assessment of vascular flow.

How long does it take to treat testicular torsion?

The chance of saving the testicle is greatest in the first hours after the onset of pain and decreases with each subsequent hour of ischemia. Therefore, in case of sudden, severe pain, you should not delay or wait until the morning.

Is epididymitis contagious?

Not the inflammation itself, but its cause may be infectious. When the background is a sexually transmitted infection, it is necessary to treat the partner in parallel and refrain from intercourse until the treatment is completed.

How long does treatment take?

The duration of antibiotic therapy depends on the cause and course and is determined by the doctor. Therapy must be continued even if the pain subsides earlier, as premature discontinuation may result in recurrence.

Why does the thickening persist despite treatment?

The swelling subsides more slowly than the pain and a noticeable thickening of the epididymis may persist for weeks. This in itself does not indicate failure, but reassessment is necessary if there is no improvement or worsening of symptoms.

Does inflammation affect fertility?

If treated correctly, it usually does not leave any lasting consequences. The risk increases in severe, bilateral cases and in mumps-related orchitis. When considering parenting plans, it is worth discussing this during the check-up.

Do cold compresses and lying down help?

Rest, elevation of the scrotum and cold compresses are complementary measures and alleviate the symptoms. However, they do not replace causal treatment or diagnosis.

What if the symptoms come back?

Recurrences require re-evaluation and searching for a contributing cause, for example residual urine, prostate enlargement or untreated infection in the partner. Repeated episodes should not be treated with another antibiotic without diagnosis.

Who consults such ailments at WMP?

On the WMP website, MD. Arthur Abbazov is described as a urologist and andrologist engaged in the diagnosis and treatment of diseases of the urogenital system in men.

Sources

• Island of Friendly Medicine, MD. Arthur Abbazov: https://www.wyspamedycynyPrzyjaznej.pl/pl/artur-abazzov
• Wyspa Medycyny Przyjaznej, urology consultation: https://www.wyspamedycynyPrzyjaznej.pl/pl/konsultacja-urologiczna
• Island of Friendly Medicine, urology: https://www.wyspamedycynyPrzyjaznej.pl/pl/urologia
• European Association of Urology, Urological Infections Guidelines: https://uroweb.org/guidelines/urological-infections
• European Association of Urology, Pediatric Urology Guidelines: https://uroweb.org/guidelines/paediatric-urology
• NHS, Epididymitis: https://www.nhs.uk/conditions/epididymitis/
• NHS, Testicular torsion: https://www.nhs.uk/conditions/testicular-torsion/
• NHS, Testicular lumps and swellings: https://www.nhs.uk/conditions/testicular-lumps-and-swellings/
• NHS, Mumps: https://www.nhs.uk/conditions/mumps/
• BASHH, United Kingdom National Guideline on the Management of Epididymo-orchitis: https://www.bashh.org/guidelines
• British Association of Urological Surgeons, information for patients: https://www.baus.org.uk/patients