Possible Epididymitis

[Matthew31]

Hi I have a regular girlfriend of 5 years. I am a 29 year old male. We had not slept with anyone else prior to being together. We broke up for a period of 3 months between July - September. During that time I slept with 4 CSW's. All protected exposures apart from maybe 5 -10 seconds if that of unprotected oral on 2 occasions.

My Girlfriend and I got back together in October. She has not slept with anyone else.  I started to have more increased urinary frequency and maybe, maybe a slight sting after urination.  I was suffering from a great deal of anxiety.

I tested for Chlaymdia, ghon and UTI on a urine test which was negative. There was also no signs of white blood cell counts or infection in my urine. I was treated with Zithromax anyway. 10 day later I resumed sex with my GF and symptoms seem to come back (urine frequency). I took more tests, all negative and was not retreated. About a week later  my testicles were sore but not swollen. I would particularly notice it during a straining bowl movement. I had been constantly touching and examining them  and was constantly peeing and suffering from a great deal of anxiety. I was constantly tensed up and had some leg and left side abdominal pain. A week later A scan showed possible epididymitis on my left testicle. Despite prior to the scan I prob felt more pain in my right testicle. I was then retreated with Zithromax and Cipro. The testicle pain slowly eventually went away especially after calming down and resuming normal routine. Meantime my gf was tested for Chlam and Ghon with a swab test and her results came back negative.

Based on these results my doctor suggesting that I resume normal unprotected sex with my GF. So far so good but I remained concerned what could have cause the original issue. Can we rule out std related bacterial infection? Could constipation and unnessecery constant urination and touching/squeezing of the testicles as a result of my anxiety have irritated my Epididymitis.

[Matthew31]

yes? no?

[Matthew31]

Thank you for your . I was tested 4 times by Naat tests and girlfriend tested negative one for stds.
So surely that can be ruled out? My urine also did was tested for uti and elevated white blood cells all of which were negative.

[Bhupinder Kaur, MD]

Hello,
Thanks for posting your query.

I can understand your concern for these symptoms.

I agree with your doctor that the testicular swelling may be most likely to be due to epididymitis. You are right in thinking that constant touching and constipation may have caused it. Bcaterial infection is the commonest cause of epididymitis but in men less than 35 years of age, apart from other bacteria, bacteria causing Chlamydia and Gonorrhea may cause epididymitis.

Basically epididymitis is an inflammatory response to sterile urine which may get refluxed through the ejaculatory ducts and vas deferens into the epididymis. Vigorous physical activity, rubbing, straining, trauma, and instrumentation can predispose to such reflux. Hence constant touching and pressing could be the factors.

Secondly, for your symptoms urethritis and prostatitis should also be ruled out. Urethritis is inflammation of the urethra and it is caused by infection by bacteria that enter the urethra from the skin around the urethra's opening. These bacteria may be present in the stools like E.coli or due to Chlamydia and gonorrhea. Feeling the frequent or urgent need to urinate and pain during urination are frequent symptoms. Prostatitis is also caused by infection by bacteria that normally live in your bowel and it may cause similar symptoms of pain during urination, frequent urination, pain in abdomen, tip of penis and scrotum and dribbling or hesitant urination.

Hence these possibilities should also be kept in mind for your symptoms. The positive point is that you have taken two courses of Zithropmax which is the treatment for epididymitis, urethritis/ prostatitis, gonorrhea and Chlamydia. Hence any of these infections have already been taken care of.

If the symptoms persist or recur then get evaluated for all these possibilities. It is possible to get false positive or false negative results with the standard tests for Chlamydia. Hence it would be wise to repeat the tests. Else you can opt for specific tests for Chlamydia which include Nucleic acid amplification tests (NAAT, to find the genetic material of Chlamydia), Nucleic acid hybridization tests (DNA probe test, Enzyme-linked immunosorbent assay (ELISA, EIA), Direct fluorescent antibody test (DFA) or chlamydia culture.

Hope that this information helps and hope that you will get better soon.

Wishing you good health.