What is epididymitis

Chronic Epididymitis can be roughly defined as tenderness and/or pain in the epididymis lasting more
than 2-3 months. The epididymis may have swelling in some cases, and it can be unilateral or bilateral.

What are the Causes of Chronic Epididymitis

General belief is that there is no infective pathogen (bacteria or virus) involved the case of chronic
epididymitis . Over-sensitive nerves and muscles are considered the cause. However, based on my
experience, I do not think this is completely correct. While it is possible to have nerve damage from
acute infections, it is definitely true that chronic epididymitis can occur without an acute infection or
nerve damage. My experience is the proof, and motivation to write this document.

For ease of communication, I think it is useful to separate chronic epididymitis into two categories:

Category-1: Infection-Related (excluding Tuberculosis)

This refers to chronic epididymitis characterized by frequent or infrequent flare-ups (acute infections),
often started as acute epididymitis from sexually or non-sexually transmitted pathogens. In addition, it
includes cases started without the symptoms of acute epididymitis, and without other causes
mentioned below (under Category-2). The discussion in this document is mainly applicable to this
category. I would also include the suspected nerve damage from frequent acute attacks here.
However, in my opinion, if there were frequent attacks, that infection is most probably not cleared,
and that alone could be the real problem. I will explain the rationale in the next chapter.

Category-2: Other Causes

Tuberculosis: Mycobacterium tuberculosis (TB) can present itself as epididymitis.
Conditions such as epididymal cyst, testicular cancer and varicocele (enlarged veins) can
cause chronic discomfort and or pain similar to epididymitis
Congenital urinary abnormalities like reverse flow of urine.
Vasectomy: chronic scrotal pain is the most common post-vasectomy complication. In
addition to the possibility of infection (Category-1), other causes of the pain include congestive
epididymitis, pain from the nerve ending at the incision etc.
Certain medications like heart rhythm drug Amiodarone (Cordarone)
Certain diseases like Behcet's disease. (Behcet's disease is an autoimmune condition that can
cause to develop mouth and genital sores along with other symptoms.) Behcet's disease is
considered non-infective.
Other causes which cannot be classified as Category-1.

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