Epididymitis (inflammation of the epididymis) is a significant cause of morbidity and is the fifth most common urologic diagnosis in men aged 18-50 years. Epididymitis must be differentiated from testicular torsion, which is a true urologic emergency.
Epididymis is a coiled tube at the back of our testicle that stores and carries sperm. This swelling can cause intense testicular pain.
Etiology
The exact etiology of acute epididymitis is unclear; however, it is believed to be caused by the retrograde passage of urine from the prostatic urethra to the epididymis via the ejaculatory ducts and vas deferens. Obstruction of the prostate or urethra and congenital anomalies create a predisposition for reflux. Normally, the oblique angle of the ejaculatory ducts through the dense prostatic tissue prevents reflux. Fifty-six percent of men older than 60 years who have epididymitis exhibit concurrent bladder outlet obstruction (BOO), such as a urethral stricture or benign prostatic hyperplasia (BPH).
Reflux may also be induced by Valsalva maneuvers or strenuous exertion. This can be seen in athletes such as weightlifters. Epididymitis is commonly found to develop during strenuous exertion in conjunction with a full bladder. Instrumentation and indwelling catheters are common risk factors for acute epididymitis.
Epididymitis may be accompanied by urethritis or prostatitis.
Acute epididymo-orchitis
Bacterial infections
Infection that is severe and extends to the adjacent testicle is termed acute epididymo-orchitis. The etiology of acute epididymo-orchitis varies with the age of the patient and may be a bacterial, nonbacterial infectious, noninfectious, or idiopathic process.
Infections with urinary coliforms (eg, E coli, Pseudomonas species, Proteus species, Klebsiella species) are the most common cause in children and in men older than 35 years. Ureaplasma urealyticum, Corynebacterium species, Mycoplasma species, and Mima polymorpha have also been isolated. Systemic Hemophilic influenzae and Neisseria meningitides infections are rare. In men who are the insertive partner during anal intercourse, infections with coliform bacteria are common etiology.
Chlamydia is the most common cause in sexually active men.
Tuberculous epididymitis can occur in endemic areas and is still the most common form of urogenital tuberculosis (TB). It is believed to spread hematogenous and often involves the kidneys.
Epididymo-orchitis may develop following bacillus Calmette-Guérin (BCG) treatment for superficial bladder cancer (at a rate of 0.4%). 
Viral Infections
Viral epididymitis is thought to be the predominant etiology of pediatric epididymitis. It is defined by the absence of pyuria. Although mumps is the most common viral cause of epididymitis, coxsackievirus A, varicella, and echoviral infections have also been identified.
Other rear Infections
Rare infections (eg, brucellosis, coccidioidomycosis, blastomycosis, cytomegalovirus [CMV], candidiasis, CMV in human immunodeficiency virus [HIV] infection, nontuberculous mycobacteria) have been implicated in epididymitis but usually occur in immunocompromised hosts.
After vasectomy
Roughly 1 in 1000 men who undergo vasectomy describe a post vasectomy pain syndrome of chronic, dull, aching pain in the epididymis and testicle. The pain is most likely secondary to chronic epididymal congestion of sperm and fluid that continues to be produced after the vasectomy. The epididymis can become distended from back pressure of this fluid, particularly following the close-ended vasectomy technique. When sperm extravasates from the end of the vas deferens, such as can occur in the open-ended vasectomy technique, a sperm granuloma may develop, with a resulting inflammatory reaction.
Etiology of chronic epididymitis
The etiology of chronic epididymitis includes the following:
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Inadequate treatment of acute epididymitis,
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Recurrent epididymitis,
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Association with a granulomatous reaction (most commonly Mycobacterium tuberculosis),
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Association with a chronic disease process such as Behçet syndrome.
What’s the difference between epididymitis and orchitis?
While epididymitis refers to inflammation of the tube at the back of testicle, orchitis refers to swelling of testicle itself. Sometimes, these two conditions occur simultaneously. When this happens, it’s called epididymo-orchitis.
Etiology of acute orchitis
Causes of acute orchitis include the following:
- Viral: Mumps orchitis was once the most common etiology; however, since the introduction of the mumps vaccine in 1985 and thanks to Homeopathy, this has been virtually eliminated.
- Bacterial and pyogenic infections: Infections with E coli, Klebsiella species, Pseudomonas, Staphylococcus species, and Streptococcus species are unusual.
- Granulomatous: T pallidum, M tuberculosis, Mycobacterium leprae, Actinomyces, and fungal diseases are rare.
- Trauma.
- Idiopathic.
With regard to a viral etiology, roughly one third of post pubertal boys with mumps have concomitant orchitis. Coxsackievirus type A, varicella, and echoviral, adenoviral, enteroviral, influenzas, and parainfluenzas infections are rare. 
What causes epididymitis?
Most cases of epididymitis are caused by an infection called E. coli. Some cases happen from bacteria called Mycoplasma or Chlamydia. These infections often come by way of sexually transmitted infections.
Other infections, including the mumps virus and rarely, tuberculosis, can also cause epididymitis.
Sometimes, epididymitis occurs when urine flows backward into epididymis. This can happen as a result of heavy lifting. Other epididymitis causes include:
- Blockage in urethra.
- An enlarged or infected prostate gland.
- Use of a catheter.
- Surgery on the prostate, urethra or bladder.
- Traumatic groin injury.
Can one get epididymitis without having an STD?
Yes. You can get epididymitis through nonsexual transmitted infections. For example, prostate or urinary tract infections can spread to your epididymis.
Is epididymitis contagious?
Yes. Epididymis can spread through sexual contact. While epididymitis isn’t categorized as an STD, it’s still a common symptom of many STDs, including chlamydia and gonorrhea.
Signs and symptoms
The following history findings are associated with acute epididymitis and orchitis:
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Gradual onset of scrotal pain and swelling, usually unilateral, often developing over several days (as opposed to hours for testicular torsion),
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Dysuria, frequency, or urgency,
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Fever and chills (in only 25% of adults with acute epididymitis but in up to 71% of children with the condition),
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Usually, no nausea or vomiting (in contrast to testicular torsion),
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Urethral discharge preceding the onset of acute epididymitis (in some cases).
Does ejaculating hurt epididymitis?
While ejaculating doesn’t make an epididymitis infection worse, it can make the pain more intense for some people. It’s best to abstain from masturbation until patient is treated, and patient definitely shouldn’t have sex with anyone until the doctor gives clearance.
Diagnosis and Tests
How is epididymitis diagnosed?
History
The following history findings are associated with acute epididymitis and orchitis: 
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Gradual onset of scrotal pain and swelling, often developing over several days (as opposed to hours, as in testicular torsion),
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Usually located on one side,
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Fever and chills (in only 25% of adult patients with acute epididymitis but in up to 71% of children with the condition),
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Usually no nausea or vomiting (as opposed to testicular torsion),
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Urethral discharge preceding the onset of acute epididymitis (in some cases).
The following history findings are associated with chronic epididymitis:
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The patient has a long-standing history of pain (>6 wk) that can be described as either waxing and waning or constant
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The scrotum is not usually swollen but may be indurated in long-standing cases
History of patients with mumps orchitis
The following history findings are associated with mumps orchitis:
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Fever, malaise, and myalgia are common,
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Parotiditis typically precedes the onset of orchitis by 3-5 days,
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Subclinical infections occur in 30-40% of patients.
Younger patients or any patient with a sexually transmitted epididymitis may note symptoms related to urethritis.
A recent history of endourethral instrumentation or urinary tract infection is more common in older patients with epididymitis.
Physical Examination
Acute epididymitis
Tenderness and induration first occur in the epididymal tail, which may be the first site of reflux via the vas deferens. It then appears to spread to the body, head, and even the spermatic cord (funiculitis) or the ipsilateral testis (epididymo-orchitis). Acute epididymitis is bilateral in 5-10% of affected patients.
When checking for the Prehn sign during an examination, the affected hemi scrotum is elevated. This action relieves the pain of epididymitis but exacerbates the pain of torsion (positive Prehn sign). The elevation takes the weight of the testis off the epididymal suspension.
Physical examination findings may fail to distinguish acute epididymitis from testicular torsion. A normal cremasteric reflex indicates that testicular torsion is less likely.
Erythema and mild scrotal cellulitis may be present, while a reactive hydrocele is common in patients with advanced epididymo-orchitis, complicating scrotal examination. Postpubertal individuals with acute epididymitis frequently have associated bacterial prostatitis and/or seminal vesiculitis.
TB can cause focal epididymitis, a draining sinus, or beading of the vas deferens with extensive involvement. Orchitis rarely occurs without epididymitis in TB.
In children, epididymitis may be related to an underlying congenital anomaly of the urogenital tract, such as urethral abnormalities, an ectopic ureter, an ectopic vas deferens, detrusor sphincter dyssynergia, or vesicoureteral reflux.
Orchitis
Testicular enlargement, induration, and a reactive hydrocele are common. The epididymis is not tender. Orchitis is found in association with acute epididymitis in 20-40% of cases. 
Diagnosis
The following laboratory studies may be indicated for suspected epididymitis:
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Urinalysis – Pyuria or bacteriuria (50%); urine culture indicated for prepubertal and elderly patients,
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Complete blood count (CBC) – Leukocytosis,
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Gram stain of urethral discharge, if present,
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Urethral culture, nucleic acid hybridization, and nucleic acid amplification tests (these tests aid in detection of N gonorrhoeae and C trachomatis),
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Performance of (or referral for) syphilis and HIV testing in patients found positive for C trachomatis or N gonorrhoeae infection,
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The use of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to differentiate epididymitis from other causes of acute scrotum is currently under investigation.
Perform blood cultures if the patient is systemically ill. The WBC count may be elevated with a left shift (10,000-30,000 cells/μL).
Urine Tests
A midstream urine culture and Gram stain are useful in guiding therapy. Urinalysis findings are positive for pyuria in only 25% of patients and are sterile in 40-90% of patients.
Obtain a urethral swab culture (before void, after prostate massage) for gonorrheal and chlamydial infections if the patient is in the at-risk age group or if the patient is older than 40 years and not monogamous. Gonorrheal infections often demonstrate gram-negative diplococci on smear, while chlamydial infections can be established in two thirds of cases when only WBCs are seen on smear. A chlamydia polymerase chain reaction (PCR) assay is highly specific and sensitive for chlamydial infection.
Immunofluorescent
If mumps orchitis is clinically suspected but the diagnosis is in doubt, use immunofluorescent antibody testing to confirm the diagnosis. Urinalysis and culture findings are negative in mumps orchitis.
Amiodarone plasma levels or antibodies are not helpful in the diagnosis of amiodarone-induced epididymitis.
Although epididymitis may often be an infectious process, cultures commonly fail to demonstrate any identifiable infection.
Imaging
It is recommended that pediatric patients be evaluated for underlying congenital anomalies via abdominopelvic ultrasonography, voiding cystourethrography, and, in some cases, cystoscopy, especially when the urine culture result is positive. Debate is ongoing as to whether further work-up is necessary only in those with recurrent episodes or also after a first episode of epididymitis or epididymo-orchitis. 
Imaging studies that may be considered to evaluate structural abnormalities and help distinguish acute epididymitis from testicular torsion include the following:
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Voiding cystourethrogram (VCUG),
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Retrograde urethrography,
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Abdominal/pelvic ultrasonography,
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Radionuclide scanning and scintigraphy. The study’s usefulness is limited by availability, cost, and difficulty with interpretation. Hydrocele and abscess cause false-positive results. Spontaneous detorsion and intermittent torsion may cause false-negative results. Radionuclide scintigraphy is used to assess testicle perfusion, yet it provides little anatomic information. Decreased perfusion suggests torsion. Increased or normal perfusion suggests epididymitis but also may be reported with actual torsion.
Radiologic study
MRI has high sensitivity and specificity for testicular torsion and is useful for differentiating epididymitis and testicular torsion when ultrasound findings are inconclusive. Radiologic studies are recommended in children who have bacteriuria and acute epididymitis in order to evaluate for structural abnormalities (found in >50% of these patients). In infants with bacteriuria and epididymitis, in whom anatomical abnormalities are more common than in older children, a voiding cystourethrogram (VCUG) and abdominal ultrasonography are recommended. Retrograde urethrography is also indicated to evaluate for urethral stricture disease as symptoms dictate. Radiologic studies for mumps orchitis are not indicated, although a reactive hydrocele is common. Patients with tuberculous epididymitis require a full workup for systemic TB. This may include chest radiography, renal function tests, or computed tomography (CT) or excretory urography.
Doppler ultrasound
Color Doppler ultrasonography is important in the diagnostic workup of epididymitis, not only for diagnosing epididymitis but to rule out testicular torsion. Increased blood flow occurs with epididymitis (see the image); no flow occurs with torsion. Testicular tumors can also appear hyperemic.
Other measures that may be useful for evaluation include the following:
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Cystourethroscopy
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Scrotal exploration or aspiration. Scrotal exploration or aspiration of the epididymis is rarely needed. If it is needed, it is performed by a urologist. Perform a scrotal exploration if torsion or tumor cannot be ruled out and for the complications of acute epididymitis and orchitis (for example abscess, pyocele, testicular infarction). Diagnosis of intra scrotal disorders is often confirmed during orchiectomy.
Differential Diagnoses
- Hydrocele.
- Nonseminomatous Testicular Tumors,
- Orchitis,
- Scrotal Trauma,
- Spermatocele,
- Testicular Seminoma,
- Testicular Torsion,
- Testicular Trauma.
What is Varicocele?
The term varicocele describes the growth of veins in the scrotum, which is comparable to varicose veins in the legs. The pampiniform plexus, which is made up of these veins, can swell and twist, causing a variety of symptoms as well as potential complications.
Varicocele develops when the valves inside the scrotum’s veins block blood flow. Instead of flowing smoothly, blood accumulates in the veins, causing them to enlarge.
Treatment
With allopathic drugs pain improves within 1-3 days and induration may take several weeks or months to resolve, where with Homeopathic medicines pain improves in few hours, and induration may take several days or weeks to resolve.
Infection of the epididymis can lead to the formation of an epididymal abscess. In addition, progression of the infection can lead to involvement of the testicle, causing epididymo-orchitis or a testicular abscess. Sepsis is a potential consequence of severe infection. Bilateral epididymitis may result in sterility due to occlusion of the ductules from peritubular fibrosis.
Patients with epididymitis secondary to a sexually transmitted disease have 2-5 times the risk of acquiring and transmitting HIV. All sexual partners of patients with epididymitis secondary to a sexually transmitted disease need referral to ensure that they receive adequate testing and treatment.
Allopathic treatment for epididymitis
How is epididymitis treated?
Allopathic treatment of epididymitis may include the following: 
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In chronic epididymitis, a 4- to 6-week trial of antibiotics effective against bacterial pathogens (especially chlamydia). The most common medications include doxycycline, ampicillin, gentamycin, ciprofloxacin, levofloxacin or trimethoprim-sulfamethoxazole, azithromycin. Isoniazid (part of the triple-drug regimen). Trimethoprim-Sulfamethoxazole (for the empiric treatment of nonspecific bacterial infection). Antibiotic treatment usually lasts about one to two weeks. Rifampin (to treat tuberculous epididymo-orchitis). Pyrazinamide is a pyrazine analog of nicotinamide that may be bacteriostatic or bactericidal against M tuberculosis, depending on the concentration of the drug attained at the site of infection. Pyrazinamide is part of the triple-drug regimen.
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When treating epididymitis secondary to Chlamydia trachomatis or Neisseria gonorrhoeae, treatment of all sexual partners. For sexually transmitted diseases – Ceftriaxone 500 mg IM in a single dose or Levofloxacin 500 mg orally once a day for 10 days plus Doxycycline 100 mg orally twice a day for 10 days.
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In prepubertal patients with epididymitis, antibiotic therapy only for young infants and those with pyuria or positive urine culture findings.
- For acute epididymitis most likely caused by enteric organisms (e.g. cases that develop after prostate biopsy, vasectomy, and other urinary-tract instrumentation procedures, with sexually transmitted organisms ruled out) CDC recommends levofloxacin 500 mg orally once a day for 10 days. Patients weighing ≥ 150 kg should also receive 1 g of ceftriaxone.
Suppurative therapy (allopathic)
In addition to allopathic antibiotics (except in viral epididymitis), the mainstays of supportive therapy for acute epididymitis and orchitis are as follows:
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Reduction in physical activity,
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Scrotal support and elevation,
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Ice packs,
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Anti-inflammatory agents,
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Analgesics, including nerve blocks,
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Avoidance of urethral instrumentation,
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Sitz baths.
Local pain can be distinguished from referred pain by spermatic cord injection with 1% lidocaine. Refractory pain that is not improved by analgesics has also been managed by denervation of the spermatic cord.
People with epididymitis can also relieve their symptoms by:
- Resting.
- Elevating their scrotum.
- Applying ice packs to the affected area.
- Drinking fluids.
- Taking nonsteroidal anti-inflammatory drugs (NSAIDs) for the pain.
Surgery
Surgical options include the following: 
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Epididymectomy: Infrequently performed in patients with acute suppurative epididymitis,
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Epididymectomy: Typically reserved for refractory cases,
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Orchiectomy: Indicated only for patients with unrelenting epididymal pain,
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Skeletonization of the spermatic cord via sub inguinal varicocelectomy: Performed in rare cases of refractory pain due to chronic epididymitis and orchialgia.
Homeopathic treatment for epididymitis
How is epididymitis treated with Homeopathy?
With Homeopathic medicines pain improves in few hours, and induration may take several days or weeks to resolve.
With Homeopathic medicines, there is no need to advise suppurative therapy because many Homeopathic medicines also have the capabilities to reduce inflammations and pains. Here are very few Homeopathic medicines for epididymitis:
Polygonum Acre
Amenorrhea. Antrum, pain in. Blepharitis. Colic, flatulent. Cough. Diarrhea. Dysentery. Dysmenia. Dysuria. Eczema. Epilepsy. Gonorrhea. Gravel. Hemorrhoids. Heart, affections of. Hysteria. Laryngitis. Nephritis. Neuralgia. Orchitis. Prostatitis. Sciatica. Spermatic cord, pain in. Spleen affections. Strangury. Ulcers.
Senega
Urinary diminished or severe increased; loaded with shreds and mucus; scalding before and after urinating. Back, bursting distending pain in kidney region. Ascites. Irritable bladder; catarrh/inflammation of mucus membrane of bladder. Blepharitis ciliaris. Hypopyon. Influenza. Iritis. Stricture, obstruction in urethra. Painful erections. Glans pain.
Belladona
Testicles hard, drawn up, inflamed. Nocturnal sweat of genitals. Flow of prostatic fluid. Desire diminished. Urine retention. Acute urinary infections. Sensation of motion in bladder as of a worm. Urine scanty, with tenesmus; dark and turbid, loaded with phosphates. Vesical region sensitive. Incontinence, continuous dropping. Frequent and profuse. Hematuria where no pathological condition can be found. Prostatic hypertrophy. 
Aconite Nepalis
Venereal inclination alternately increased and diminished. Amorous paroxysms. Smarting in the parts. Contusion like pains in the testicles. Testicles swollen, hard, as if surcharged with semen. Orchitis. Gonorrhea, first stage. Itching in the prepuce. Shootings and pinching in the glans when making water.
Arnica Montana
Testicles hard, drawn up, inflamed. Nocturnal sweat of genitals. Flow of prostatic fluid. Desire diminished. Tendency to tissue degeneration, septic conditions, abscesses that do not mature. Sore, lame, bruised feeling. Neuralgias. Rheumatism of muscular and tendinous tissue. Influenza. Thrombosis. Hematocel.
Agnus Castus
Yellow discharge from urethra. No erections. Impotence. Parts cold, relaxed. Desire gone. Scanty emission without ejaculation. Loss of prostatic fluid on straining. Gleety discharge. Testicles, cold, swollen, hard, and painful.
Antimuonium Tartaricum
Burning in urethra during and after urinating. Last drops bloody with pain in bladder. Urging increased. Catarrh of bladder and urethra. Stricture. Orchitis.
Argentum Metallicum
Crushed pain in testicles. Seminal emissions, without sexual excitement. Frequent micturition with burning. Diuresis. Urine profuse, turbid, sweet odor. Frequent urination. Polyuria.
Argentum Nitricum
Impotence. Erection fails when coition is attempted. Cancer-like ulcers. Desire wanting. Genitals shrivel. Coition painful. Urine passes unconsciously, day and night. Urethra inflamed, with pain, burning, itching, pain as from a splinter. Urine scanty and dark. Emission of a few drops after having finished. Divided stream. Early stage of gonorrhea; profuse discharge and terrible cutting pains; hematuria.
Aurum Metallicum
Pain and swelling of testicles. Chronic induration of testicles. Violent erections. Atrophy of testicles in boys. Hydrocele.
Baryta Carbonicum
Diminished desire and premature impotence. Enlarged prostate. Testicles indurated. Urging to urinate. Burning in urethra. 
Berberus Vulgaris
Neuralgia of spermatic cord and testicles. Smarting, burning, stitching in testicles, in prepuce and scrotum. Burning pains. Sensation as if some urine remained after urinating. Urine with thick mucus and bright-red, mealy sediment. Bubbling, sore sensation in kidneys. Pain in bladder region. Pain in the thighs and loins on urinating. Frequent urination: urethra burns when not urinating.
Bromium
Swelling of testicles. Indurated, with pains worse slight jar.
Sarsaparilla
Bloody, seminal emissions. Intolerable stench on genitals. Herpetic eruption on genitals. Itching on scrotum and perineum. Syphilis; squamous eruption and bone pains. Gravel. Renal colic.
Medorrhinum
Nocturnal emissions, followed by great weakness. Impotence. Gleet: whole urethra feels sore. Urethritis. Enlarged and painful prostate with frequent urging and painful urination. Nocturnal enuresis. Renal colic. Urine flows very slowly.
Nux Vomica
Easily excited desire. Emissions from high living. Bad effects of sexual excesses. Constrictive pain in testicles. Orchitis. Spermatorrhea, with dreams, backache, burning in spine, weakness and irritability. Irritable bladder; from spasmodic sphincter. Frequent calls; little and often. Hematuria. Ineffectual urging, spasmodic and strangury. Renal colic extending to genitals, with dribbling urine. While urinating, itching in urethra and pain in neck of bladder.
Pulsatilla Pratensis
Orchitis; pain from abdomen to testicles. Thick, yellow discharge from urethra; late stage of gonorrhea. Stricture: urine passed only in drops, and stream interrupted. Acute prostatitis. Pain and tenesmus in urinating, worse lying on back. Spasmodic pain in bladder.
Rhododendron Ferrugineum
Testicles, worse left, swollen, painful, drawn up. Orchitis; glands feel crushed. Induration and swelling of testes after gonorrhea. Hydrocele.
Spongia Tosta
Swelling of spermatic cord and testicles, with pain and tenderness. Orchitis. Epididymitis. Heat in parts.
Caladium Seguinum
Pruritus. Glans very red. Organs seem larger, puffed, relaxed, cold, sweating, skin of scrotum thick. Erections when half-asleep; cease when fully awake. Impotency; relaxation of penis during excitement. No emission and no orgasm during embrace.
Clematis Erecta
Ilio-scrotal neuralgia. Testicles indurated with bruised feeling. Swelling of scrotum (Orchitis). Right half only. Troubles from suppressed gonorrhea. Violent erections with stitches in urethra. Testicles hang heavy or retracted, with pain along spermatic cord; worse, right side.
Tingling in urethra lasting sometime after urinating. Frequent, scanty urination; burning at orifice. Interrupted flow. Urethra feels constricted. Urine emitted drop by drop. Inability to pass all the urine; dribbling after urinating. Pain worse at night, pain along the spermatic cord. Commencing stricture. 
Silicia Tera
Burning and soreness of genitals, with eruption on inner surface of thighs. Chronic gonorrhea, with thick, fetid discharge. Elephantiasis of scrotum. Sexual erethism; nocturnal emissions. Hydrocele. Bloody urine, involuntary, with red or yellow sediment. Prostatic fluid discharged when straining at stool.
Phosphoric Acidum
Emissions at night and at stool. Seminal vasculitis. Sexual power deficient; testicles tender and swollen. Parts relax during embrace. Prostatorrhea, even when passing a soft stool. Eczema of scrotum. Edema of prepuce, and swollen glans-penis. Herpes preputialis. Sycotic excrescences. Phosphaturia.
Pulsatilla Pratensis
Itching and tickling in prepuce and scrotum. Itching-burning on the inner and upper side of the prepuce. Inflammatory swelling of testes and spermatic cords, with pressive and drawing pains, extending into abdomen and loins, inflammations of scrotum. Burning in testicles, without swelling. Testicles hang low down. Dropsical swelling of scrotum of a whitish blue color. Excessive increase of sexual passion, almost like priapism, with frequent and prolonged erections, ardent desire for coition, and frequent pollutions. Flow of prostatic fluid. Inflammation of prostate gland.
Mezereum
Enlargement of testicles. Violent sexual desire. Gonorrhea, with hematuria. Red flakes float on top of urine. Hot, bloody Biting, burning in forepart of urethra at the close of micturition. Hematuria preceded by cramp pain in the bladder, after urinating, a few drops of blood are passed.
Hepar Sulphur
Herpes, sensitive, bleed easily. Ulcers externally on prepuce similar to chancre. Excitement and emission without amorous fancies. Itching of glans, frenum, and scrotum. Suppurating inguinal glands. Fig warts of offensive odor. Humid soreness on genitals and between scrotum and thigh. Obstinate gonorrhea “does not get well”. Bladder difficulties of old men.
Hamamelis Virginia
Pain in spermatic cord, running into testes. Varicocele. Pain in testicles. Orchitis. Testicles enlarged, hot, and painful. Epididymitis.
Mercurius Solubilis
Vesicles and ulcers; soft chancre. Cold genitals. Prepuce irritated, itches. Nocturnal emissions, stained with blood. Frequent urging. Greenish discharge from urethra; burning in urethra on beginning to urinate. Urine dark, scanty, bloody, albuminous.
Mercurius Corrosivus
Penis and testes enormously swollen. Chancres assume phagedenic appearance. Gonorrhea; urethra orifice red, swollen; glans sore and hot. Discharge greenish, thick. Intense burning in urethra. Urine hot, burning, scanty or suppressed; bloody, greenish discharge. Albuminous. Tenesmus of bladder. Stabbing pain extending up urethra into bladder. Perspiration after urinating.
Cinnabaris
Prepuce swollen; warts on it which bleed easily; testicles enlarged; buboes; angry-looking chancres. Syphilides, squamous and vesicular.
Fluoricum Acidum
Burning in urethra. Sexual passion and desire increased with erections at night, during sleep. Swollen scrotum. Urine scanty, dark. In dropsy, produces frequent and free discharge, with great relief.
Oxalic Acidum
Frequent and copious. Burning in urethra and pain in glans when urinating. Must urinate when thinking of it. Urine contains oxalates. Terrible neuralgic pains in spermatic cord. Testicles feel contused and heavy. Seminal vasculitis.
Thuja Occidentalis
Inflammation of prepuce and glans; pain in penis. Balanitis. Gonorrheal rheumatism. Gonorrhea. Chronic induration of testicles. Pain and burning felt near neck of bladder, with frequent and urgent desire to urinate. Prostatic enlargement. Urethra swollen inflamed. Urinary stream split and small. Sensation of trickling after urinating. Severe cutting after urination. Frequent micturition accompanying pains. Desire to urinate is sudden and urgent but cannot be controlled. Paralysis sphincter vesicae. 
What are complications of epididymitis?
Complications associated with acute epididymitis and bacterial orchitis include the following:
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Scrotal abscess and pyocele,
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Testicular infarction: Cord swelling can limit testicular artery blood flow,
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Fertility problems,
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Testicular atrophy,
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Cutaneous fistulization from rupture of an abscess through the tunica vaginalis (seen especially in tuberculosis),
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Recurrence, chronic epididymitis, and orchialgia.
With regard to fertility problems, sterility is uncommon after acute epididymitis, although the true incidence is unknown. Disturbances in the sperm quality secondary to leukocytospermia and inflammation are usually transient. In all cases, azoospermia is more important but far less common, which can be caused by the epididymal duct obstruction observed in men with untreated or improperly treated epididymitis. The incidence of this condition is unknown.
Complications associated with mumps orchitis include the following:
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Hypogonadotropic hypogonadism could occur as a result of testicular atrophy, which can be observed in 30-50% of patients.
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Sterility could occur in 7-13% of affected patients; orchitis affects the testicular interstitium more than the Leydig and Sertoli cells, but sperm counts, mobility, and morphology can be affected.
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Orchialgia may develop.
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Mumps orchitis is not associated with the development of testicular tumors.
Will epididymitis go away?
With proper treatment especially Homeopathic, epididymitis will go away. It’s important to seek treatment as soon as possible to avoid further complications.
P. S: This article is only for doctors and students having good knowledge about Homeopathy and allopathy.
For proper consultation and treatment, please visit our clinic.
Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.
Senior research officer at Dnepropetrovsk state medical academy Ukraine.
Location: Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.
Find more about Dr Sayed Qaisar Ahmed at:
https://www.youtube.com/Dr Qaisar Ahmed