Epididymitis and orchitis are two conditions that cause pain and discomfort in a man’s testicular area. Their causes, symptoms, and treatment are similar, so they are often discussed together.
Typically, men have two testicles — small, egg-shaped glands contained in a skin sac called the scrotum. (The testicles are also called the testes.) The testicles have some important functions:
- They produce hormones, especially testosterone, which is responsible for secondary sex characteristics like facial hair and a deeper voice. Testosterone also contributes to a man’s sex drive.
- They make sperm cells, which are needed for human reproduction. When a sperm cell fertilizes an egg cell, an embryo is created and pregnancy begins.
Sitting on top of each testicle is a coiled tube called the epididymis. (The plural is epididymides.) Once sperm cells are created by the testicle, they mature in the epididymis. They remain there, “in storage,” until they’re ready to fertilize eggs. (The epididymis is connected to a vas deferens, a tube that helps sperm cells move along into the urethra when they’re ejaculated.)
Now that we’ve gone over the anatomy, let’s look at the two condition names again.
- Epididymitis is inflammation of the epididymis, the coiled section on top of the testicle.
- Orchitis is inflammation of the testicle itself. (You’ll often see the prefix orch- in medical terms that refer to the testicles.)
Epididymitis and orchitis can happen separately, and epididymitis can lead to orchitis. But they can also happen at the same time. Doctors may use the term epidymo-orchitis when both areas are affected. You might also hear a doctor say “epididymitis” when they mean both epididymitis and orchitis.
Epididymitis and orchitis can happen separately, and epididymitis can lead to orchitis. But they can also happen at the same time.
Most of the time, just one testicle and/or epididymis are affected. But it’s possible for some men to experience it in both testicles and epididymides.
Epididymitis and orchitis are sometimes described as acute or chronic. The acute form starts quickly, but it usually responds well to treatment. The chronic form develops slowly and lasts 6 weeks or longer. Symptoms might get better for a while, then flare up again. However, symptoms of the chronic form tend to be less severe.
Because epididymitis and orchitis have similar causes, symptoms, and treatments, we will discuss them together.
What causes epididymitis and orchitis?
Epididymitis and orchitis are usually caused by a bacterial infection starting somewhere in the urinary tract. The urinary tract consists of:
- The kidneys, which filter blood and produce urine
- The bladder, which stores urine until you go to the bathroom
- The ureters, two tubes that connect each kidney to the bladder
- The urethra, the tube urine passes through when you urinate
A prostate infection (prostatitis) can also lead to epididymitis and orchitis.
E. coli is a common bacterial cause, especially in children, men older than 35, and men who have sex with men. In rare cases, epididymitis is caused by bacteria related to tuberculosis (TB), an illness that usually affects the lungs.
In sexually active men, epididymitis and orchitis may be caused by bacteria related to gonorrhea and chlamydia, both sexually transmitted infections (STIs). This means that the bacteria can be spread through vaginal, oral, and anal sex. (People with STIs should always let their partners know about their diagnosis, as the partners also may have the infection and need treatment.)
Epididymitis has also been linked to a drug called amiodarone, which is prescribed to prevent abnormal heart rhythms (arrhythmia).
The mumps virus can also cause epididymitis and orchitis. Symptoms typically begin about a week after the parotid glands (salivary glands) start swelling. Mumps is often the cause of orchitis that happens on its own, without epididymitis.
Men might be at higher risk for epididymitis and orchitis if they:
- Have a history of urinary tract problems (such as blockage)
- Have a history of urinary tract infections (UTIs)
- Have benign prostatic hyperplasia (an enlarged prostate)
- Have had surgery in the urinary tract
- Use a urethral catheter regularly
- Have more than one sex partner
- Have sex without a condom
- Have a history of an STI
- Have a sexual partner with a history of an STI
- Have narrowing and scarring in the urinary tract (urethral stricture)
People who have not been vaccinated against mumps are also at higher risk for epididymitis and orchitis. In the United States, many people are vaccinated against mumps as children. Some people receive the MMR vaccine, which protects against the mumps, measles, and rubella. There is also an MMRV vaccine, which protects against mumps, measles, rubella, and varicella (chickenpox), although that vaccine is available only to children aged 1 to 12 years.
If you don’t know your vaccination status, talk to your doctor.
What are the symptoms of epididymitis and orchitis?
Epididymitis and orchitis have symptoms in common:
- Tenderness, pain, or a feeling of heaviness in the scrotum and testicle
- Tenderness, pain, or swelling in the lower abdomen or pelvis
- Swelling or the formation of a lump on the scrotum
- Redness
- Fever and chills
- Discharge from the penis
- Enlarged lymph nodes
- Blood in the semen
- Pain or discomfort during urination (dysuria)
- Pain during bowel movements
- Pain or discomfort during ejaculation
How are epididymitis and orchitis diagnosed?
Your doctor will start by asking you questions about your symptoms and your medical history. They will also do a physical exam.
You may have other tests, such as the following:
- Blood tests to check for infections
- Imaging tests to get a better look inside the scrotum and testicles
- Urinalysis – lab tests that check for harmful substances in the urine
- Urine culture – a lab test to see if bacteria or fungi grow in a urine sample
- Tests for sexually transmitted infections, especially gonorrhea and chlamydia
If you have a discharge of fluid from your urethra, your doctor might test a sample of that as well.
How are epididymitis and orchitis treated?
If the problem is caused by a bacterial infection, antibiotics are usually prescribed. Some examples are doxycycline, ciprofloxacin, and levofloxacin. Most men take their antibiotics at home for a week or two.
If the epididymitis or orchitis is caused by a STI, that will also be treated with medicine. It’s extremely important to notify anyone you’ve had sex with over the past two months that you have this diagnosis. Your partner(s) may be infected with the STI also, and they might not have symptoms to let them know that something is wrong. If you do have an STI, your doctor will likely ask you to come back for further testing after treatment to make sure the infection is gone.
If tuberculosis is the cause, your doctor might prescribe isoniazid-pyrazinamide-rifampin, ethambutol, or rifapentine. You might need to take these medicines for several months.
If your doctor prescribes medicine, it’s important to take the full course. Take every dose as directed for as long as your doctor tells you to. Don’t stop taking your medicine just because you start feeling better.
If the drug amiodarone is causing epididymitis, your doctor may lower your dose or change the medication you take.
Your doctor will also suggest ways to ease the pain and discomfort of epididymitis and orchitis. You might try over-the-counter medications, like acetaminophen, ibuprofen, or naproxen.
Here are some other ways to ease the discomfort:
- Lie down with your scrotum elevated and rest.
- Place a cold pack on the area every few hours. Make sure the cold pack doesn’t touch your skin directly. Some men use ice packs or bags of frozen vegetables. Keep the cold pack on the area for about 15 minutes and re-apply every few hours.
- Wear supportive underwear or an athletic supporter (jock strap).
Because mumps is a virus, it does not respond to antibiotics. If you have mumps orchitis, your doctor will likely recommend ways to stay comfortable while the virus runs its course.
Your doctor may recommend avoiding sexual activity, including masturbation, until your infection clears.
Most men with epididymitis and orchitis start feeling better within a few days of treatment and don’t have any long-term sexual problems afterward. However, these illnesses can come back. If you have symptoms again, see your doctor as soon as you can.
Men with severe cases of epididymitis or orchitis may need to spend some time in the hospital. Surgery to remove the epididymis or the testicle may be necessary.
How can I lower my risk for epididymitis and orchitis?
If you think you might have a UTI or other urological issue, see your doctor right away, and get treatment before the situation worsens.
It’s also important to always practice safe sex. Make sure you use a latex condom during every sexual encounter. Get tested for STIs and be sure to know your partner’s status as well. If you or your partner has any symptoms of an STI, such as genital itching or discharge, see a doctor for treatment. Don’t have sex again until you know the infection is clear.
Getting vaccinated against mumps may also lower risk.
Keep hygiene in mind as well. For example, washing your hands regularly can reduce your risk for many infections.
What complications of epididymitis and orchitis should I know about?
While rare, there are some complications of epididymitis and orchitis to be aware of:
- Abscess (pus-filled lump)
- Tear in the skin of the scrotum
- Shrinking or death of testicular tissue
- Infertility, especially after orchitis caused by mumps
Summary
- Epididymitis refers to inflammation of the epididymitis, a coiled tube on top of the testicle. Orchitis is inflammation of the testicle itself.
- It’s possible for epididymitis and orchitis to happen separately, but they often happen at the same time. This situation is called epidymo-orchitis.
- Both epididymitis and orchitis can be caused by bacterial infections, such as urinary tract infections and sexually transmitted infections like gonorrhea or chlamydia. They can also be caused by the mumps virus.
- To diagnose epididymitis and orchitis, doctors do a physical exam. They may also order blood tests, imaging tests, STI tests, urinalysis, or a urine culture to get more information.
- Treatments for epididymitis and orchitis depend on the cause. For example, if you have a bacterial infection, your doctor may prescribe antibiotics. Be sure to take your medicine exactly as prescribed.
- If you have an STI, your partner(s) should be notified and treated as well.
- If you have discomfort related to epididymitis and orchitis, over-the-counter pain relievers and cold packs might help. You can also lie down with your scrotum elevated.
- You can lower your risk for epididymitis and orchitis by treating urological issues as soon as possible. If you have symptoms that concern you, don’t ignore them. Call your doctor. We understand it might be awkward to discuss genital health. But remember, your doctor is there to help you.
- Practicing safe sex is also important for preventing epididymitis and orchitis. Be sure to use a condom every time you have sex. Don’t have sex if you or your partner have any STI symptoms, such as genital pain, itching, swelling, or rashes.
Resources
Centers for Disease Control and Prevention
“Mumps Vaccination”
(January 17, 2025)
https://www.cdc.gov/mumps/vaccines/index.html
Cleveland Clinic
“Epididymitis”
(Last reviewed: October 1, 2024)
https://my.clevelandclinic.org/health/diseases/17697-epididymitis
“Mumps”
(Last reviewed: September 29, 2022)
https://my.clevelandclinic.org/health/diseases/15007-mumps
“Orchitis”
(Last reviewed: November 22, 2024)
https://my.clevelandclinic.org/health/diseases/21658-orchitis
Frontiers in Immunology via the National Library of Medicine
Wu, Han, et al.
“Mumps Orchitis: Clinical Aspects and Mechanisms”
(March 18, 2021)
https://pmc.ncbi.nlm.nih.gov/articles/PMC8013702/
MedlinePlus
“Epididymitis”
(Review Date 9/2/2024)
https://medlineplus.gov/ency/article/001279.htm
“Orchitis”
(Review Date 1/1/2025)
https://medlineplus.gov/ency/article/001280.htm
StatPearls (National Library of Medicine)
Azmat, Chaudhary Ehtsham and Pradeep Vaitia
“Orchitis”
(Last Update: June 26, 2023)
https://www.ncbi.nlm.nih.gov/books/NBK430814/
Rupp, Timothy J. and Stephen W. Leslie
“Epididymitis”
(Last Update: July 17, 2023)
https://www.ncbi.nlm.nih.gov/books/NBK430814/
Up to Date
“Patient education: Epididymitis and orchitis (The Basics)”
(Accessed: July 23, 2025)
https://www.uptodate.com/contents/epididymitis-and-orchitis-the-basics
Urology Care Foundation
“What are Epididymitis and Orchitis?”
(Updated: April 2024)
https://www.urologyhealth.org/urology-a-z/e/epididymitis-and-orchitis