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Epididymoorchitis

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I contracted chlamydia back in may 2013 and had it for 5 and a half months before realising and got it treated right away with a single dose of azithromicin. During the time of having the infection I showed no symptoms and hadn't had any kind of sex with anyone else since I contracted the infection. 3 weeks after the treatment on the 1st of December I got myself tested for chlamydia again and it was all clear. After Christmas on the 2nd of January I got myself treated again as the test I did back in December was a test you send away and not going into the clinic so thought it may not have been accurate so went to the clinic for this test. About 6 days after I went into the clinic I went down with usual cold like symptoms one night (hot and cold, didn't sleep very well, but no pain in testicles) the following night was much the same with cold like symptoms but when I was bed my left testicle started to ache with a very warm feeling to it. The flu like symptoms subsided after this night but stomach pains continued and I couldn't eat much for 4-5 days. The ache only really occurred when sitting or lying. There was no discharge, no redness in the testicle and no swelling in the testicle. The results were once again clear with the STI test on the second of January. I went to a doctor 2 weeks later as my testicles were still aching, but i would have said the pain had subsided a bit. He diagnosed it as acute Epididymitis from my chlamydia infection and have me a weeks course of doxycycline. 2 days into the treatment my left testicle became a lot more painful when sleeping and found it hard to sleep so there was some kind of reaction to the antibiotics. This only lasted for 2 days and then the pain subsided. It is now 2 weeks after starting the treatment and my testicles feel mainly fine but there is definatly a bit of an odd feeling in the left one and if you tap the left testicle it is a lot more sensitive than the right one. I went to see a doctor 3 days ago and he examined my testicle and said the epididymis was not swollen, and the cause Of it all was probably a UTI infection. but he said chlamydia can't cause Epididymitis that can't be true. What do you think has caused my testicle to hurt? Would chlamydia have given me Epididymitis 7 weeks after being treated with 2 clear sit results having not had sex with anyone after treatment? And should I be worried about my testicles still being sensitive? And fertility?

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
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Hello,

Thank you for choosing DoctorSpring. Considering the specific nature of your query I have discussed your concern with our team Urologist. You most likely had an epididymo orchitis . There are three possible causes here :

1. Chlamydia
2. Gonorrhoea
3. A non infectious Epididymo orchitis

Chlamydia is very likely. But the lack of response is the one fact that causes a concern. Even if you had a sexual intercourse after the first Chlamydia episode you still can get an epididymo orchitis. Since you have good resolution of symptoms at this stage you need not consider any other possibility. The " odd feeling in the left one and if you tap the left testicle it is a lot more sensitive than the right one " - this is not a big concern. From our experience we find that many patients experience vague testicular symptoms even after cure for 4-6 weeks. This is not to be worried about.

However if the major symptoms recur, I would recommend a single injection of Ceftriaxone to treat a possible Gonorrhoea. If that scenario arises you should discuss this with your Doctor. A non infectious epi-orchitis can also cause these symptoms. Noninfectious epididymitis is generally a chronic condition. It can be precipitated by trauma, autoimmune disease, or vasculitis. However, no etiology is found in many cases. Idiopathic noninfectious epididymitis is thought to occur due to reflux of urine through the ejaculatory ducts and vas deferens into the epididymis, producing a "chemical" inflammation with resultant swelling, causing obstruction.

Again you need not worry about this possibility now as there was good resolution. So myr recommendations would be :


1.Give it some time 2-4 weeks for complete symptom resolution
2.If it persists , consider further testing and a Ceftriaxone injection.
3. Non infectious epi- orchitis to be the kept in mind.

Hope this helps
Feel free to ask followups
With inputs from Dr.Gautam Banga


Patient replied :

Well the doctor that diagnosed it as Epididymitis felt my testicle and there was no pain in the testicle itself it was on the back where the epididymis is and there has been no swelling in the testicle or much in the epididymis as he only thought that it was Epididymitis when I said it felt sore to touch not from any obvious swelling. The testicle itself has been fine it's only when you tap it it is sensitive, never when it is has been lightly squeezed. So this might be that it is being pushed into something when it's tapped. What is the likelihood it was a UTI rather than the chlamydia I was treated for. And I HAVE NOT had sex since I got treated for chlamydia so it could only be from the original chlamydia. What is the chances there has been permanent damage done to my reproductive organs? And is there a chance I might not be able to father a child? And would the non-infectious Epididy or chitin be from the chlamydia or something else?


It is practically bit difficult to differentiate epididymitis and epi orchitis. But this is not a problem since the approach, treatment and management are always same. It could be the same Chlamydia (if it is Chlamydia in the first place) you contracted during sex. Moreover epididymitis is not always a sexually transmitted disease , so you never know.

No an infection should not affect your reproductive capacity under usual circumstances. So you need not worry about this. I have explained how a non infectious epididymitis can occur. (please see my previous reply). At this stage, you need to be patient and see how the symptoms evolve. DO NOT over worry or think about it all the time. You could end up feeling testicular pain even if there is nothing wrong.

Hope this helps
Feel free to ask followups
Thank you


Patient replied :

So if it is Epididymitis or epididimo orchitis then they should have both cleared up from the doxycycline? Ever since finding out I have had chlamydia I have wanted to know if 5 and a 1/2 months is an 'average' or 'very long time' to have chlamydia for a male and if there are usually complications caused by this stage? and just to clarify if it is only one testicle and the other has shown no signs of anything over all of this then that one is fine and would be enough to keep me fertile? Would you have said my situation has been usual circumstances??


Yes it should be cleared from now as you do not have any symptoms. Since Chalmydia is an infection, once it is cleared it will not have any residual damage. Under normal circumstances this is NOT going to affect your fertility. 5 + months is a pretty long time. And again there is a possibility that this could be some other infection or a non infectious cause. Either Way it is ulikey to affect your reproductive capacity. Hope this helps
Thank you


Patient replied :

Oh okay so even if I was to have had it for only 2-3 months rather than 5, so Long as it has been cleared it shouldn't have a big effect having it for this period of time? Thanks very much for help!


Hello,

Time duration is not the important factor. Rather than the type of infection is. For example mumps infection, even if it is there for 1 week or so can cause sterility.
Usually Chalmydia does not cause such issue. To be sure you can go for a Semen Analysis after 2-3 months.
Thank you


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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