Diagnosis of Epididymitis
The diagnosis of epididymitis is usually based on a physical examination, patient history, and laboratory tests. Because epididymitis can mimic other serious conditions—such as testicular torsion—accurate and timely diagnosis is crucial, especially in younger patients.
Medical History and Symptom Review
Doctors begin by asking about:
The onset and duration of pain
Urinary symptoms, such as burning or frequency
Any discharge from the penis
Recent sexual activity or known STI exposure
History of urinary tract infections, catheter use, or trauma
This information helps narrow down the likely cause—whether it’s an STI, UTI, or a non-infectious trigger.
Physical Examination
During the exam, the doctor will:
Check for swelling, tenderness, and warmth in the scrotum
Examine both testicles and the epididymis
Assess for signs of inflammation or discharge
Rule out testicular torsion, a condition where the spermatic cord twists and cuts off blood supply—a surgical emergency that requires immediate attention
The Prehn’s sign may be used: lifting the scrotum slightly relieves pain in epididymitis but not in testicular torsion. However, this test alone is not always reliable.
Urine and Swab Tests
Urinalysis – Detects white blood cells, bacteria, or blood in the urine
Urine culture – Identifies the bacteria causing infection
NAAT (nucleic acid amplification tests) – Detect chlamydia and gonorrhoea
Urethral swab – In cases of discharge, swabs help identify the STI organism
These tests help guide antibiotic selection and confirm whether the infection is sexually transmitted or related to a urinary cause.
Blood Tests | Diagnosis of Epididymitis
A full blood count (FBC) may reveal elevated white cells, indicating infection. CRP or ESR levels can also confirm inflammation.
Scrotal Ultrasound
Ultrasound with Doppler imaging is the most reliable test to confirm epididymitis and rule out torsion. It shows:
Blood flow to the testicles
Swelling of the epididymis
Fluid build-up around the testicles (hydrocele)
In South Africa, access to ultrasound may be limited in rural clinics, causing delays in diagnosis. In such cases, clinical assessment becomes even more important.
The diagnosis of epididymitis should be made quickly and confidently. Early treatment prevents complications and offers rapid symptom relief.
[Next: Treatment of Epididymitis →]
