Epididymitis: What Causes It, How It's Diagnosed, and How Long Recovery Takes — A Complete Guide
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
Epididymitis is inflammation of the epididymis, a coiled tube at the back of the testicle that stores and carries sperm [4]. It causes testicle, scrotum or groin pain, swelling and sometimes fever [4]. Under 35, STIs are the most common cause [2] [4]; over 35, it is usually infected urine [2] [4]. Bacterial epididymitis needs antibiotics [4], and most people improve within about three days [4].
What the research says
Sudden scrotal pain can be a surgical emergency, and time matters. In a case series of 502 patients who needed emergency scrotal exploration for acute scrotal pain, 46% had testicular torsion and 9.2% had epididymal inflammation. A longer duration of symptoms was significantly associated with needing the testicle removed in torsion (4 vs 27 hours, p < 0.0001), which supports urgent evaluation of sudden scrotal pain at any age (PubMed: Nandwani et al., J Coll Physicians Surg Pak, 2020 [1]).
Treatment depends on age and the likely germ. A clinical review reports that gonorrhea and chlamydia are the most common causes in sexually active males aged 14 to 35, treated with a single intramuscular dose of ceftriaxone plus 10 days of oral doxycycline, while men over 35 usually have enteric bacteria carried by urine reflux, for which levofloxacin or ofloxacin alone is sufficient. The authors stress that untreated acute epididymitis can lead to infertility and chronic scrotal pain (PubMed: McConaghy & Panchal, Am Fam Physician, 2016 [2]).
Fertility can be affected even after antibiotics. A review of clinical and animal research notes that studies have shown persistent low sperm counts (oligozoospermia) or no sperm (azoospermia) in up to 40% of patients managed with antimicrobial therapy, which is why recognizing and treating epididymitis early matters (PubMed: Michel et al., Asian J Androl, 2015 [3]).
Antibiotic choice still rests largely on expert guidance. An expert review states that most acute epididymitis is caused by bacterial infection, most often sexually transmitted organisms and urinary pathogens, that the first antibiotic is chosen empirically based on the most likely germ, and that relatively sparse direct trial data exist on antimicrobial treatment (PubMed: Khastgir, Expert Opin Pharmacother, 2022 [5]).
In children, fever, a high CRP and reduced blood flow flag worse outcomes. In a single-hospital review of 142 children with acute epididymitis (median age 9 years), 137 had favorable testicular outcomes and 5 had poor outcomes (atrophy, necrosis or abscess); fever (p = 0.001), C-reactive protein levels (p = 0.002) and decreased testicular blood flow on ultrasound (p < 0.001) were significantly associated with poor outcomes (PubMed: Furugane et al., Pediatr Surg Int, 2025 [6]).
Abscesses and low sperm counts can follow despite antibiotics. A study combining a mouse model with human tissue and blood samples notes in its background that, despite antibiotic treatment, up to 20% of patients develop abscesses in the tail of the epididymis and 40% have low sperm counts (PubMed: Hasan et al., Mucosal Immunol, 2025 [7]).
What Is Epididymitis?
Epididymitis (pronounced up-uh-DID-uh-MI-tis) is inflammation of your epididymis (pronounced ep-uh-DID-uh-miss). This inflammation causes discomfort or pain in your scrotum, testicle, or the epididymis itself [4].
Your epididymis is a coiled tube at the back of your testicle. Most people have one epididymis behind each testicle (the plural is epididymides [4]). Its job is to store and carry sperm [4].
Inflammation anywhere in your body can be painful and uncomfortable, and it can feel even more distressing when it affects a sensitive area. But inflammation is your body's way of telling you something is wrong [4], and you should talk to a healthcare provider. They will work to identify what is causing your pain and treat you promptly.
About 600,000 cases of epididymitis occur in the United States each year [4].
Term | What it means |
Epididymis | A coiled tube at the back of your testicle that stores and carries sperm [4] |
Epididymitis | Inflammation of the epididymis |
Acute epididymitis | Symptoms develop suddenly and worsen; usually a bacterial infection [4] |
Chronic epididymitis | Discomfort or pain lasting six weeks or longer; may come and go [4] |
Scrotum | The pouch of skin that holds the testicles |
Orchitis | Swelling of the testicle itself |
Epididymo-orchitis | When epididymitis and orchitis occur at the same time [4] |
Types of epididymitis
Symptoms: What Does Epididymitis Feel Like?
Pain in your scrotum may move to the rest of your groin [4]. The pain may be on one side or both sides, and it may be mild or severe [4].
Symptom | What you may notice |
Pain in your scrotum | Pain may move to the rest of your groin; on one side or both sides; mild or severe [4] |
Swollen testicles | Visible swelling of the scrotum [4] |
Fever and chills | Signs your body is fighting infection [4] |
Pain when you pee (dysuria) | Burning or pain during urination [4] |
Blood in your semen (hematospermia) | Visible blood in semen [4] |
Causes: What Causes Epididymitis?
A bacterial infection is the most common cause of acute epididymitis [4]. But the likely cause depends a lot on your age.
If you are older than 35, the most common cause is the backflow of infected urine down your ejaculatory tract to the epididymis [2] [4]. The most common bacteria linked to this is E. coli [4]. Men who have sex with men also have an increased risk of epididymitis from exposure to gastrointestinal bacteria, such as E. coli [2] [4]. Other infections can also cause epididymitis, including the mumps virus and, rarely, tuberculosis [4].
Less common causes
Less common cause | Why it can lead to epididymitis |
A blockage in your urethra [4] | Disrupts normal flow and allows bacteria to build up |
The infection can spread to the epididymis | |
Using a urinary catheter (like a Foley catheter) [4] | Can introduce bacteria into the urinary tract |
An injury to your groin [4] | Trauma can trigger inflammation |
The arrhythmia medication amiodarone [4] | A drug-related (non-infectious) cause |
Can you get epididymitis without an STI?
Yes, you can get epididymitis through nonsexually transmitted infections. For example, prostate infections and urinary tract infections (UTIs) can spread to your epididymis [4].
Is it contagious?
Yes, epididymitis can spread through sexual contact [4]. While healthcare providers don't categorize it as an STI, it is still a common symptom of many STIs, including chlamydia and gonorrhea [4].
Who does this condition affect?
Males develop epididymitis. It can occur at any age, but it happens most often in people between the ages of 14 and 35 [4].
Complications: What Can Happen Without Treatment?
Without treatment, epididymitis can cause the following complications. You can help prevent them by seeking treatment as soon as you notice symptoms.
Diagnosis: How Is Epididymitis Diagnosed?
A healthcare provider will ask you questions about your symptoms and perform a physical examination of your scrotum to look for a tender area or lump [4]. They may also order the following tests.
Test | What it does |
Physical examination | Checks the scrotum for a tender area or lump [4] |
Urinalysis (pee test) | Looks for the presence of bacteria in a urine sample [4] |
Blood tests | Examines a blood sample for signs of infection [4] |
Bacteria swab tests | A swab inserted into your urethra is tested for STI pathogens [4] |
Ultrasound | Images of your scrotum in some cases to help make the diagnosis [4] |
What can be mistaken for epididymitis?
The following conditions share similar symptoms with epididymitis.
Condition | How it compares |
Testicle infection (orchitis) | Swelling of the testicle itself, rather than the tube behind it [4] |
A surgical emergency [1] — twisted testicle cutting off blood flow | |
Testicular tumor | Can present with a lump; rarely painful |
Rarely causes pain or swelling; routine follow-ups rule it out [4] |
Epididymitis vs. orchitis
Treatment: How Is Epididymitis Treated?
Epididymitis treatment depends on the cause [4].
Bacterial epididymitis
If bacteria cause epididymitis, treatment involves antibiotics [4]. For infections likely caused by an STI, CDC recommends a single ceftriaxone injection plus doxycycline; for infections from urinary bacteria, levofloxacin is commonly used [4]. Most people need to take antibiotics for about one to two weeks [4]. In rare cases, you may need a prolonged course of antibiotics [4].
Medication | Category |
Doxycycline | Antibiotic |
Ciprofloxacin | Antibiotic |
Levofloxacin | Antibiotic |
Trimethoprim-sulfamethoxazole | Antibiotic |
Tuberculosis epididymitis
If tuberculosis causes epididymitis, a healthcare provider may prescribe isoniazid-pyrazinamide-rifampin, ethambutol, or rifapentine [4]. Most people need to take antituberculosis medications for six to nine months [4]. In severe cases, a surgeon may need to remove one or both of your epididymides (an epididymectomy) or testicles (an orchiectomy) [4].
Amiodarone epididymitis
If the arrhythmia medication amiodarone causes epididymitis, a healthcare provider may reduce your dosage or prescribe another medication [4]. Talk to a provider before you adjust or stop taking amiodarone [4].
Other causes
Epididymitis treatment varies for non-infection causes. A healthcare provider will talk to you about how to stay comfortable [4].
Does epididymitis go away on its own?
Bacteria cause most cases of epididymitis. Bacterial epididymitis cases will not go away on their own [4]. It is important to talk to a healthcare provider as soon as you notice symptoms to get proper treatment and avoid further complications.
Does ejaculating help epididymitis?
Ejaculating won't make epididymitis worse [4]. But it can make the pain more intense for some people [4]. You shouldn't have sexual intercourse with anyone until a healthcare provider says it's OK [4]. It is also best to avoid masturbation until you complete your treatment [4].
Can I treat symptoms at home?
You can't self-treat most cases of epididymitis. It is important to talk to a healthcare provider for an official diagnosis and treatment. But you can help relieve epididymitis symptoms with the following.
Home relief step | What it does |
Resting | Reduces strain while your body heals |
Elevating your scrotum [4] | Eases pressure and swelling |
Applying ice packs to your scrotum or groin [4] | Numbs pain and reduces swelling |
Wearing tight-fitting underwear [4] | Supports the area and reduces swelling |
Drinking lots of fluids, especially water [4] | Supports recovery |
Taking NSAIDs for pain | Reduces pain and inflammation; not everyone can take NSAIDs — ask your provider first [4] |
How long does it take to heal?
Healing time depends on the cause.
Cause | Healing timeline |
Bacterial | Start feeling better a few days after starting antibiotics; swelling can take several weeks to improve; discomfort or swelling possible for weeks or even months after finishing antibiotics [4] |
Tuberculosis | Up to nine months to heal with medications [4] |
Amiodarone | Start feeling better shortly after reducing your dosage or stopping the medication [4] |
Surgery (epididymectomy or orchiectomy) | Worsening pain may occur immediately after surgery due to swelling; several weeks to feel better [4] — but that doesn't mean the surgery was ineffective |
Outlook: What Can I Expect?
In most cases of epididymitis, a healthcare provider will prescribe antibiotics to treat the infection and ease your symptoms [4], and will give you advice on how to relieve discomfort at home. While epididymitis can be painful, it usually doesn't cause any long-term problems, especially with early treatment [4]. Be sure to talk to a healthcare provider as soon as you notice symptoms.
Question | What the evidence says |
How long does it last? | Most treated people start to feel better after about three days; symptoms may continue for weeks or even months after treatment [4] |
Must I finish antibiotics? | Yes — finish your full course even if you feel better; otherwise epididymitis may return and be harder to treat [4] |
If symptoms return? | Follow up with a provider; they can rule out other conditions that affect your testicle [4] |
Long-term outlook? | Usually no long-term problems, especially with early treatment [4] |
Although testicular cancer rarely causes pain or swelling, routine follow-ups with a provider are important to rule out cancer or other conditions [4].
Prevention: Can It Be Prevented?
You can help reduce your risk of epididymitis with the following practices.
Prevention step | Why it helps |
Use condoms during sexual intercourse [4] | Reduces exposure to STIs, the leading cause in people under 35 |
Wash your hands regularly with clean water and soap [4] | Reduces the spread of bacteria |
Cover your mouth when you sneeze or cough [4] | Reduces the spread of respiratory infections, including mumps |
Stay up to date on vaccines [4] | Protects against vaccine-preventable infections like mumps |
If you have recurrent urinary tract infections or other risk factors for epididymitis, a healthcare provider may talk with you about other ways to help prevent it [8].
Living With Epididymitis: When to See a Provider
Call a healthcare provider if you develop any symptoms of epididymitis. If they conclude that your infection is due to an STI, be sure to let your recent sexual partners know [4] so they can schedule an appointment with a provider and get treatment.
When should you go to the ER?
Head to your nearest emergency room or call 911 (or your local emergency number) if you develop sudden or severe testicular pain [4].
Questions to ask your provider
Question | Why it helps |
What's the cause? | Identifies whether it's an STI, UTI, medication, or something else |
What antibiotics do you recommend? | Confirms your treatment plan |
Do I need any further testing? | Ensures nothing is missed |
How long will it take before I feel better? | Sets realistic recovery expectations |
How long do I need to avoid sexual activity? | Protects you and your partner |
Should my sexual partner(s) get an STI test? | Prevents reinfection and spread |
Pain in or around your testicles might not be something that's easy to talk about. But even though it might feel embarrassing, it's important to get it checked out. Providers are caring and professional, and they will do their best to make your visit as stress-free as possible. Remember to take all medications exactly as prescribed and follow their recommendations to ensure a successful recovery.
Key Takeaways
Epididymitis is inflammation of the epididymis, the coiled tube behind your testicle that stores and carries sperm. It causes scrotal pain, swelling, fever, and sometimes pain when urinating or blood in semen. In the United States it affects about 600,000 people each year, most often between ages 14 and 35. The cause usually depends on age: STIs under 35, and backflow of infected urine (often E. coli) over 35. Bacterial epididymitis will not resolve on its own — antibiotics are required, and the full course must be finished. With early treatment, most people feel better within about three days, and long-term problems are uncommon. Never ignore sudden or severe testicular pain — seek emergency care immediately.
Take the Next Step
If you have pain or swelling in your scrotum or groin, contact a healthcare provider promptly — early treatment prevents complications. Don't let embarrassment delay care.
Related reading: Testicular Torsion · Prostatitis · E. coli Infection · Chlamydia · Urinary Tract Infection (UTI)
Further reading: CDC — STI Treatment Guidelines: Epididymitis · Urology Care Foundation — What Are Epididymitis and Orchitis? · MedlinePlus — Epididymitis
Frequently Asked Questions
1. What is epididymitis?
Epididymitis is inflammation of the epididymis, a coiled tube at the back of your testicle that stores and carries sperm. It causes pain in the scrotum, testicle, or groin, and is most often caused by a bacterial infection. It does not go away on its own and requires treatment.
2. How common is epididymitis?
There are about 600,000 cases of epididymitis in the United States each year. It can occur at any age but happens most often in people between ages 14 and 35.
3. What are the symptoms of epididymitis?
Symptoms include pain in the scrotum (possibly spreading to the groin), swollen testicles, fever and chills, pain when urinating, and blood in semen. Pain may be on one or both sides and range from mild to severe.
4. What causes epididymitis?
Bacterial infection is the most common cause. Under 35, STIs like gonorrhea and chlamydia are most common. Over 35, infected urine usually flows back into the epididymis, often with E. coli. Prostate infections, UTIs, mumps, TB, groin injury, catheters, and the drug amiodarone can also cause it.
5. Does epididymitis go away on its own?
No. Bacteria cause most cases, and bacterial epididymitis will not go away on its own. Antibiotics are needed, and the full course should be completed even after you feel better.
6. How long does epididymitis last?
Most treated people start feeling better after about three days. Swelling can take several weeks to improve, and some discomfort may continue for weeks or months after finishing antibiotics.
7. What antibiotics treat epididymitis?
For STI-related cases, CDC recommends a single ceftriaxone injection plus 10 days of doxycycline; for cases from urinary bacteria, levofloxacin for 10 days is common. Tuberculosis-related cases need six to nine months of antituberculosis medication.
8. What's the difference between epididymitis and orchitis?
Epididymitis is inflammation of the tube at the back of your testicle. Orchitis is swelling of the testicle itself. When both occur together, it's called epididymo-orchitis.
9. When should I go to the ER for testicular pain?
Go to your nearest emergency room or call 911 (or your local emergency number) if you develop sudden or severe testicular pain. This can signal testicular torsion, which needs immediate treatment.
10. How can I relieve epididymitis pain at home?
While antibiotics treat the cause, you can relieve symptoms by resting, elevating your scrotum, applying ice packs, wearing tight-fitting underwear, drinking plenty of fluids, and taking NSAIDs if your provider says they are safe for you.
11. Can epididymitis cause infertility?
In rare cases, untreated epididymitis can cause male infertility problems, and it can also lead to a scrotal abscess or broken skin. Seeking treatment early helps prevent these complications.
Related Reading
Gonorrhea Test: Types, Who Should Get Tested and What Results Mean explains how gonorrhea is tested and what results mean.
References
Nandwani GM, Anwar A, Singh R, et al. Assessment of age and duration of symptoms on outcomes of emergency scrotal exploration for acute scrotal pain. J Coll Physicians Surg Pak. 2020;30(2):201-204. doi:10.29271/jcpsp.2020.02.201. PMID: 32036831.
McConaghy JR, Panchal B. Epididymitis: an overview. Am Fam Physician. 2016;94(9):723-726. PubMed. PMID: 27929243.
Michel V, Pilatz A, Hedger MP, Meinhardt A. Epididymitis: revelations at the convergence of clinical and basic sciences. Asian J Androl. 2015;17(5):756-763. doi:10.4103/1008-682X.155770. PMID: 26112484.
Cleveland Clinic. Epididymitis. Cleveland Clinic Health Library. Medically reviewed; last updated October 1, 2024. https://my.clevelandclinic.org/health/diseases/17697-epididymitis
Khastgir J. Advances in the antibiotic management of epididymitis. Expert Opin Pharmacother. 2022;23(9):1103-1113. doi:10.1080/14656566.2022.2062228. PMID: 35380486.
Furugane R, Mitsunaga T, Komatsu S, et al. Clinical characteristics of pediatric acute epididymitis: a single institute review of 142 cases. Pediatr Surg Int. 2025;41(1):278. doi:10.1007/s00383-025-06168-7. PMID: 40884544.
Hasan H, Pleuger C, Ai D, et al. Epididymitis promotes formation of tertiary lymphoid organs in the cauda epididymidis. Mucosal Immunol. 2025;18(6):1405-1423. doi:10.1016/j.mucimm.2025.10.001. PMID: 41076012.
Mayo Clinic Staff. Epididymitis - Symptoms and causes. Mayo Clinic. October 14, 2025. https://www.mayoclinic.org/diseases-conditions/epididymitis/symptoms-causes/syc-20363853
Medical Disclaimer
This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read here.
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