Urethritis / Orchitis / Epididymitis

These are infections of the male Genital System, specifically of the urethra, the testis, and epididymis, respectively (see Diagram: the Male Genital System). Women also have a urethra, although female urethritis is uncommon (see Diagram: the Female Genital System and also of The Urinary System). Men can also get Prostatitis, either Acute (rare) or Chronic.

Urethritis — This is virtually always caused by an STD, either Gonorrhea or Chlamydia.  A newly identified STD, Mycoplasma genitalium, may also be responsible for many cases.  When women get Urethritis, itโ€™s often misdiagnosed as a typical urinary tract infection (UTI), which then doesnโ€™t get better because the antibiotics used are different for each.  Men can have Urethritis from irritation that isn’t an infection, which nobody understands well. 

Diagnosis is made by urine tests for STD germs (see the links to them).  When we look for UTIโ€™s, we tell patients to begin to urinate in the toilet, then catch some in the cup (a midstream specimen).  However, for STDs causing urethritis, we prefer just the first little bit (a tablespoon, 15 ml. at the most, which means starting to pee in the cup and removing it real quick).

It takes a day or two for the STD tests to come back. So we also do a dipstick Urinalysis (UA) during the patient visit, With Urethritis, the UA is almost always positive for Leukocyte Esterase, which would lead us to treat on the spot. If the UA is negative, we wait for formal STD results.

Orchitis — An infection of the actual testis (testicle), Orchitis is rare. It’s also quite painful, and may cause a fever. In a young man, STD germs are the most likely cause, but we’d also test for a regular Urinary Tract Infection. In older men, and men with weak immune systems from other diseases, regular UTI’s are much more likely. Both are diagnosed by urine tests, but different ones.

Like Urethritis above, urine tests that give a definite diagnosis may take several days to come back. If we find a positive UA in the office, we’d start treatment immediately. Older men with orchitis may need to be hospitalized for IV antibiotics. This is especially so if they have a fever.

Epididymitis — The Epididymis is where sperm mature after being produced in the testicle. It lies behind and on top of the testicle, but is really separate from it. With Epididymitis, the epididymis is tender and often swollen. We deal with Epididymitis the same way as both Urethritis and Orchitis above. Young men likely have STDs as above; older men may have UTI-type bacteria (E. coli).

Diagnosis is made by physical exam; then we find the cause by urine tests.  If there’s an infection, treatment involves antibiotics (for the correct germ).  The danger of epididymitis is that it can cause scarring, which can contribute to future infertility.  Like any untreated infection, there’s also a rare possibility of it spreading to the blood.

Some Epididymitis is caused by simple inflammation, maybe from straining (nobody really knows), but are not infections, since the urine tests are all negative. In those cases, we treat with pain medications like NSAIDs, not antibiotics.

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