Can You Get Epididymitis Without Having an STI?

Women often get tagged as the sex with the most complicated, perplexing, capriciously painful reproductive system, and there's plenty of truth with the perception.

If men had to put up with pregnancy, Pap smears and periods, every corner store and grocery would sell painkiller-laced beer.

But fellas, you've got some pretty wild stuff going on down there, too. Men can encounter excruciating outliers such as testicular torsion and breaking your penis, though these conditions are extremely rare.

However, one common affliction is epididymitis, an often painful testicle condition that affects about 600,000 men per year in the United States and is frequently triggered by a sexually transmitted infection (STI). It's not dangerous, but it does require treatment.

However, epididymitis is not only sexually transmitted. Here's the rundown on how you can get it—and how you can get rid of it.

What are the symptoms of epididymitis?

Epididymitis is the inflammation or irritation of the epididymis, a tightly coiled tubule at the back of each testicle that carries sperm to the vas deferens, a duct that conveys the sperm to the urethra for ejaculation.

Symptoms of epididymitis include:

• Scrotal pain that sometimes spreads to the rest of the groin area
• Redness and swelling of the testicle
• Painful urination
• Blood in the semen
• Chills and fever

A medical professional's detective work to discover an underlying cause of epididymitis often starts with a simple question: How old are you?

"For younger guys in their late teens or early 20s who develop this condition, it could be from an STI, particularly if they've had a recent unprotected sexual encounter," said Petar Bajic, M.D., a urologist with the Cleveland Clinic.

In fact, although epididymitis can occur at any age, it's most likely to affect boys and men between the ages of 14 and 35, which puts sexually transmitted infections at the top of the possible culprits list. The STIs most commonly associated with epididymitis are chlamydia and gonorrhea, which travel up the urethra all the way to the epididymis and sometimes even to the testicle.

"These infections often cause a urethritis [infection of the urethra], which migrates through the genitourinary tract to the epididymis and/or testicle," said David Barham, M.D., a fellow in reconstructive urology at the University of California at Irvine. "They're often a cause of epididymitis or epididymo-orchitis when the testicle is also involved."

Epididymitis caused by an STI is treated with antibiotics—usually a single-dose intramuscular shot of ceftriaxone followed by doxycycline tablets for 10 days, according to the Centers for Disease Control and Prevention.

Figuring out what's going on down there, or even knowing anything is wrong, can take a minute.

"People can have an STI and not have any symptoms from it or have symptoms that they don't notice," Bajic said. "Potentially, the first sign might be epididymitis." You can transmit this STI to a partner, so do seek treatment from your healthcare provider.

Another possible cause of epididymitis for men who practice penetrative anal sex is an infection caused by bacteria, such as E. coli, which can enter the urinary tract. This type of epididymitis is also treated with an intramuscular shot of ceftriaxone but is followed by a 10-day regimen of a different antibiotic, levofloxacin.

Other causes of epididymitis beyond an STI

Younger men and boys who aren't sexually active can still get epididymitis because of another fairly common cause that has to do with urine.

Epididymitis in boys ages 14 and younger is often caused by a reflux of urine into the ejaculatory ducts due to anatomic irregularities, according to the journal American Family Physician. It can also occur as part of a post-infectious syndrome following a bout of pneumonia or another infection.

Epididymitis isn't a life-threatening or dangerous condition, although if left untreated, it can lead to chronic testicular pain or even an abscess in the scrotum.

"What can happen is you can get urine that backs up into the vas deferens and can cause irritation as far down as the epididymis," Bajic said. "So this is a noninfectious cause. We call this a chemical epididymitis."

To treat this type of epididymitis infection, the CDC recommends using levofloxacin for 10 days. But do get it treated. While it isn't dangerous on its own, left untreated, it can cause serious issues.

Older men and the cause behind epididymitis

While the demographic for epididymitis trends younger, older men aren't completely free and clear. Once men pass age 35, they are considered less likely to get epididymitis through sexual activity—thanks so much for the vote of confidence, CDC. But as prostate issues come into play in concert with urinary problems, older men can develop infections that result in epididymitis.

"Later on in life, when men start developing things like prostate enlargement—men in their 60s, 50s, sometimes younger—they can also get an issue where urine can back up and carry with it bacteria," Bajic said. "They can get a bacterial infection causing epididymitis."

Urinary tract infections (UTI) are also a common cause of epididymitis, and, unfortunately, older guys are more likely to encounter them with prostate trouble.

"UTI is a more common cause in older men who have urinary obstruction from an enlarged prostate," Barham said. "They have to generate higher pressures to urinate and can have more stagnation of urine in the urinary tract, allowing for migration of bacteria to the testicle and epididymis."

Heavy lifting can sometimes cause urine to reverse and back up all the way into the epididymis, as well.

Epididymitis isn't a life-threatening or dangerous condition, although if left untreated, it can lead to chronic testicular pain or even an abscess in the scrotum.

While STIs are usually the cause, it's best not to assume anything until you've been examined by a doctor. If you have pain or swelling in your testicles, get it checked out sooner rather than later to determine whether it's epididymitis—and to be sure it's not something more serious.