Epididymitis, orchitis and prostatitis
- Lesion
Infection usually reaches the epididymis first; mumps and syphilis prefer the testis; prostatitis can be acute, chronic or granulomatous.
What it is
Inflammation of the male genital organs usually comes from the urinary tract or sexual transmission. Epididymitis is more common than orchitis. Under 35 the usual causes are Chlamydia trachomatis and Neisseria gonorrhoeae; in older men, gut organisms from urinary infections. Mumps causes orchitis after puberty. Tuberculosis begins in the epididymis; syphilis begins in the testis. Granulomatous (autoimmune) orchitis causes a painful mass in middle-aged men. Prostatitis is acute bacterial, chronic bacterial, chronic abacterial (pelvic pain syndrome) or granulomatous, including after intravesical BCG.
Structure
- Nonspecific epididymitis: congestion, edema and neutrophils, then abscesses; healing leaves fibrosis that can block the duct.
- Granulomatous orchitis: noncaseating granulomas within tubules and interstitium.
- Mumps: interstitial edema with lymphocytes, tubular damage and later focal atrophy.
- Prostatitis: neutrophils in acini and stroma; chronic forms show lymphocytes, plasma cells and macrophages.
Infections and inflammation of male genital organs
| Disorder | Where it starts | Clue |
|---|---|---|
| Nonspecific epididymitis | Epididymis | Age-related organisms; scarring can cause infertility |
| Granulomatous (autoimmune) orchitis | Testis | Painful mass in middle age; noncaseating granulomas |
| Mumps orchitis | Testis | After puberty, with or after parotitis |
| Tuberculosis | Epididymis | Caseating granulomas, may spread from the kidney |
| Syphilis | Testis | Gummas, plasma cells, endarteritis |
| Prostatitis | Prostate | Acute fever and tender gland, or chronic pelvic pain |
Clinical notes
- Epididymitis gives gradual pain relieved by lifting the testis; torsion gives sudden pain and must be excluded urgently.
- In Colombia tuberculosis remains frequent and genital involvement can mimic a tumour.
Test yourself
Think of the answer, then tap the question to see it.
What are the usual causes of epididymitis in a 25-year-old man?
Sexually transmitted Chlamydia trachomatis and Neisseria gonorrhoeae.
Which infection starts in the testis rather than the epididymis?
Syphilis.
Which treatment for bladder cancer can cause granulomatous prostatitis?
Intravesical BCG instillation.
Elsewhere in DurgiPedia
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Epididymitis (StatPearls (NCBI Bookshelf), 2024); Acute Bacterial Prostatitis (StatPearls (NCBI Bookshelf), 2024).
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Representative model, for educational purposes only.