Chronic Epididymitis Causes and Diagnosis

Men who practice insertive anal intercourse are at risk for epididymitis caused by enteric organisms (e.g., Escherichia coli) 1
Recent urinary tract instrumentation or surgery can cause epididymitis in men over 35 years 1
Anatomical abnormalities of the urinary tract can also cause epididymitis in men over 35 years 1

Special Considerations

Fungal infections are more likely to cause epididymitis in immunosuppressed patients, according to the Centers for Disease Control and Prevention 2, 3
Mycobacterial infections, particularly tuberculosis, can present as epididymitis in immunocompromised patients, as reported by the Centers for Disease Control and Prevention 2

Physical examination typically reveals a swollen, tender epididymis, as recommended by the Centers for Disease Control and Prevention 1
Urethral evaluation, including Gram-stained smear of urethral exudate for diagnosis of urethritis, is recommended by the Centers for Disease Control and Prevention 1
Urine studies, including examination of first-void urine for leukocytes and culture and Gram-stained smear of uncentrifuged urine, are recommended by the Centers for Disease Control and Prevention 1

Persistent symptoms after appropriate antimicrobial therapy warrant comprehensive evaluation for other conditions, including tumor, abscess, infarction, testicular cancer, and tuberculous or fungal epididymitis, as recommended by the Centers for Disease Control and Prevention 2