Epididymitis and Orchitis Treatment | Dr. Theodore Cisu

The short answer: Epididymitis is inflammation, usually from an infection, of the epididymis, the coiled tube behind the testicle that stores and carries sperm. Orchitis is inflammation of the testicle itself, and the two often happen together. Most cases get better with the right antibiotics, rest, scrotal support and anti-inflammatory medicine. Because sudden testicle pain can also be testicular torsion, a surgical emergency, new severe pain needs to be checked right away.

Written by Theodore Cisu, MD, board-certified urologist. There is no AUA guideline specific to epididymitis, so this article is based on the CDC Sexually Transmitted Infections Treatment Guidelines (2021) and patient information from the Urology Care Foundation, the foundation of the American Urological Association. Last reviewed November 2026.

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What are epididymitis and orchitis?

The epididymis sits along the back of each testicle. When it becomes infected or inflamed, it swells and gets tender. That's epididymitis. When the inflammation spreads to the testicle, it's called epididymo-orchitis. Orchitis on its own, without the epididymis involved, is less common and is most often caused by a virus such as mumps.

Doctors also separate acute epididymitis, which comes on over days and usually clears with treatment, from chronic epididymitis, which the CDC describes as pain or discomfort lasting six weeks or longer.

Symptoms of epididymitis and orchitis

• Pain and tenderness, usually on one side, often starting behind the testicle
• Swelling, redness or warmth of the scrotum
• Fever or chills
• Burning with urination or needing to go often
• Discharge from the penis, if the cause is a sexually transmitted infection
• Fluid collecting around the testicle, which can make the swelling look bigger

The pain of epididymitis often builds over hours to days. Torsion usually starts suddenly. That's a helpful clue for doctors, but it isn't reliable enough to sort out at home.

What causes epididymitis? Causes by age and sexual activity

Sexually active men, especially younger men

The most common causes are the sexually transmitted infections chlamydia and gonorrhea. Mycoplasma genitalium is another. These infections often start in the urethra and may cause no symptoms there at all.

Men who have insertive anal sex

Bowel bacteria such as E. coli can cause epididymitis, in addition to sexually transmitted infections.

Older men

Epididymitis is more often caused by the same bacteria that cause bladder infections. It's often linked to trouble emptying the bladder from an enlarged prostate, a recent urinary catheter, a prostate biopsy or another urinary procedure.

Boys and teens

Epididymitis can happen in boys and teens, but torsion is more common in this age group. Any boy or teen with new testicle pain should be seen right away.

Other causes

• Mumps: The classic cause of orchitis, mainly in males who get mumps after puberty. The MMR vaccine helps prevent it.
• Medication: The heart medicine amiodarone can cause epididymitis that improves when the dose is lowered or the drug is stopped.
• Tuberculosis and fungal infections: Rare causes, mainly of long-lasting cases.
• Urine flowing backward into the epididymis, which can happen with heavy straining.

When it's an emergency: ruling out torsion

Go to the emergency room or call 911 if you have:

• Sudden, severe pain in a testicle, especially with nausea or vomiting
• A testicle that sits higher than usual or at an odd angle
• Severe pain or swelling after an injury
• High fever, shaking chills or feeling very sick
• Swelling and redness that are spreading quickly

The CDC guidelines stress that torsion must be considered whenever pain starts suddenly. In torsion, the testicle twists and cuts off its own blood supply. According to the Urology Care Foundation, lasting damage can begin after about six hours. Telehealth is a good fit for follow-up, but new, sudden testicle pain needs an in-person emergency exam.

How is epididymitis diagnosed?

• History and exam: Your doctor asks when the pain started, about urinary symptoms and sexual history, and examines the scrotum.
• Urine tests: A urinalysis looks for white blood cells. The CDC recommends a urine culture for all men with epididymitis, to identify the bacteria and which antibiotics work.
• STI testing: A urine test for chlamydia and gonorrhea. The CDC also recommends testing all men with epididymitis for HIV and syphilis.
• Scrotal ultrasound: Used mainly to rule out torsion or an abscess. A normal ultrasound doesn't rule out epididymitis.

Treatment options

Antibiotics

Treatment usually starts at the visit, before test results come back. The CDC guidelines choose antibiotics based on the most likely cause:

• Likely chlamydia or gonorrhea: A one-time ceftriaxone injection plus 10 days of doxycycline
• Insertive anal sex: A one-time ceftriaxone injection plus 10 days of levofloxacin, to also cover bowel bacteria
• Likely urinary bacteria only (often older men, once gonorrhea is ruled out): 10 days of levofloxacin

Your doctor may adjust the antibiotic once the culture results are back. Finish the full course even if you feel better.

Comfort measures

• Rest, especially for the first few days
• Raise and support the scrotum with snug briefs or an athletic supporter
• Use ice packs wrapped in a cloth
• Take anti-inflammatory medicine such as ibuprofen, if it's safe for you

The CDC notes it can take several weeks after antibiotics for the pain to go away completely.

Partners and sex

If chlamydia or gonorrhea is suspected or confirmed, avoid sex until you and your partners have finished treatment and your symptoms are gone. The CDC recommends that partners from the 60 days before your symptoms started be tested and treated.

Hospital care

A small number of men need hospital care for severe pain, high fever, vomiting or an abscess. Rarely, an abscess needs to be drained or damaged tissue removed. Your urologist can discuss these options if they come up.

Mumps orchitis

Antibiotics don't treat viral orchitis. Care focuses on rest, support, ice and pain relief, and it usually improves with time.

Recovery and follow-up

You should start to feel better within about three days of treatment. If you don't, the CDC advises going back to be re-checked. If swelling or a firm area is still there after treatment, your doctor will look for other causes, such as an abscess or a testicular tumor, usually with an ultrasound.

When to see a urologist

• Symptoms that aren't improving after three days of antibiotics
• Swelling, firmness or a lump that remains after treatment
• Repeat episodes of epididymitis
• Pain that lasts six weeks or longer
• Epididymitis along with urinary symptoms, trouble emptying the bladder or an enlarged prostate

Seeing Dr. Cisu for epididymitis or orchitis

If you've been diagnosed in an urgent care or emergency room and want follow-up, or your symptoms aren't clearing, you can start with a telehealth visit from anywhere in Virginia. Our office can request your ultrasound, urine cultures and records so Dr. Cisu reviews them before you talk. Second opinions are welcome. In-person visits are available at clinics in Charlottesville and Fishersville, and no referral is needed. Book an appointment.

Frequently asked questions

Is epididymitis an STI?

Sometimes. In sexually active men, chlamydia and gonorrhea are common causes. In older men, it's more often caused by ordinary urinary bacteria. Testing helps sort this out.

How long does epididymitis last?

Most men start to feel better within a few days of antibiotics. Swelling and tenderness can take several weeks to fully settle.

Can epididymitis cause infertility?

It can, but it's uncommon. Most men who have had epididymitis on one side can still father children. Prompt treatment helps lower the risk of complications.

How can I tell epididymitis from testicular torsion?

You can't safely tell at home. Torsion usually starts suddenly, while epididymitis often builds more slowly, but there's overlap. Sudden, severe testicle pain needs the emergency room.

Does my partner need treatment?

If your epididymitis may be from a sexually transmitted infection, yes. Recent partners should be tested and treated, even if they have no symptoms.

Can epididymitis come back?

Yes. Repeat episodes, or pain that lingers for weeks, are reasons to see a urologist and look for an underlying cause, such as trouble emptying the bladder.

Can I have sex while being treated?

If an STI is possible, wait until you and your partners have finished treatment and your symptoms are gone.

Sources

• Centers for Disease Control and Prevention. Epididymitis: Sexually Transmitted Infections Treatment Guidelines, 2021.
• Urology Care Foundation. Epididymitis and Orchitis.
• Urology Care Foundation. Testicular Torsion.

This article is for general education and isn't a substitute for medical advice. If you have sudden, severe testicle pain, call 911 or go to the nearest emergency room.