Causes of Epididymitis
The causes of epididymitis vary depending on a person’s age, sexual activity, and overall health. Epididymitis most commonly results from infections—either sexually transmitted or related to the urinary tract—but it can also develop without infection in some cases.
Sexually Transmitted Infections (STIs)
In men under 35, epididymitis is often caused by sexually transmitted bacteria, including:
Chlamydia trachomatis
Neisseria gonorrhoeae
These infections can travel through the urethra and into the reproductive tract, inflaming the epididymis. STIs are a leading cause among sexually active young men, particularly in areas with limited access to regular screening and sexual health education.
Urinary Tract Infections (UTIs)
In older men, epididymitis is commonly associated with:
Escherichia coli (E. coli) and other common UTI-causing bacteria
Enlarged prostate (BPH), which can lead to urine retention and increased risk of infection
Catheter use or recent urological procedures
Infections from the bladder or prostate may spread backward to the epididymis, causing inflammation and pain.
Non-Infectious causes of Epididymitis
Less common causes include:
Trauma or injury to the groin
Heavy lifting or straining, which may cause urine to flow backward (chemical epididymitis)
Certain medications, such as amiodarone, a heart drug known to irritate the epididymis in high doses
Tuberculosis (TB), which can cause chronic epididymitis in rare cases—more commonly seen in South Africa due to the high TB burden
Risk Factors
Several factors increase the risk of developing epididymitis:
Having multiple sexual partners or unprotected sex
History of urinary tract infections
Recent prostate or bladder surgery
Use of urinary catheters
Prolonged sitting (such as long road trips or desk jobs)
In South Africa, men in rural communities may delay seeking treatment due to stigma or poor access to healthcare, which increases the risk of complications and further spread of infection.
Understanding the causes of epididymitis helps doctors identify the most effective treatment and helps individuals take steps to prevent future episodes.
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