Editing Epididymitis (section)

==Diagnosis==
[[File:Ultrasonography of epididymitis.jpg|thumb|[[Doppler ultrasound]] of epididymitis, seen as a substantial increase in blood flow in the left epididymis (top image), while it is normal in the right (bottom image). The thickness of the epididymis (between yellow crosses) is only slightly increased.]]

Diagnosis is typically based on symptoms.<ref name=AFP2016/> Conditions that may result in similar symptoms include [[testicular torsion]], [[inguinal hernia]], and [[testicular cancer]].<ref name=AFP2016/> [[Doppler ultrasound|Ultrasound]] can be useful if the diagnosis is unclear.<ref name=AFP2016/>

Epididymitis usually has a gradual onset. Typical findings are redness, warmth, and swelling of the scrotum, with tenderness behind the testicle, away from the middle (this is the normal position of the epididymis relative to the testicle). The [[cremasteric reflex]] (elevation of the testicle in response to stroking the upper inner thigh) remains normal.<ref name=AFP2016/> This is a useful sign to distinguish it from testicular torsion. If there is pain relieved by elevation of the testicle, this is called [[Prehn's sign]], which is, however, non-specific and is not useful for diagnosis.<ref>{{Cite web |url=http://www.aafp.org/afp/990215ap/817.html |title=Diagnosis and Treatment of the Acute Scrotum - February 15, 1999 - American Academy of Family Physicians |access-date=May 19, 2008 |archive-date=June 6, 2011 |archive-url=https://web.archive.org/web/20110606042106/http://www.aafp.org/afp/990215ap/817.html |url-status=dead }}</ref>
Before the advent of sophisticated [[medical imaging]] techniques, surgical exploration was the standard of care. Today, [[Doppler ultrasound]] is a common test: it can demonstrate areas of blood flow and can distinguish clearly between epididymitis and torsion. However, as torsion and other sources of testicular pain can often be determined by palpation alone, some studies have suggested that the only real benefit of an ultrasound is to assure the person that they do not have testicular cancer.<ref name=baran>{{Cite book|title=Urogenital pain in clinical practice|last=Granitisioti|first=P.|editor1-last=Baranowski|editor1-first=Andrew Paul |editor2-last=Abrams|editor2-first=Paul|editor3-last=Fall|editor3-first=Magnus|chapter=Scrotal pain conditions|year=2008|publisher=Informa Healthcare USA|place=New York|chapter-url=https://books.google.com/books?id=ZGA5vzK3V4cC&pg=PA238|isbn=978-0849399329}}</ref>{{rp|p.237}} [[Nuclear medicine|Nuclear]] testicular blood flow testing is rarely used.{{citation needed|date=May 2021}}

Additional tests may be necessary to identify underlying causes. In younger children, a urinary tract anomaly is frequently found. In sexually active men, tests for [[sexually transmitted infection]]s may be done. These may include [[microscopy]] and [[Microbiological culture|culture]] of a first void urine sample, [[Gram stain]] and culture of fluid or a swab from the [[urethra]], [[nucleic acid amplification test]]s (to amplify and detect microbial [[DNA]] or other [[nucleic acid]]s) or tests for [[syphilis]] and [[HIV]].

===Classification===
[[File:Suppurative epidydimo orchitis histopathology.jpg|thumbnail|right|Histopathology image of inflamed epididymis and testis]]
Epididymitis can be classified as acute, subacute, and chronic, depending on the duration of symptoms.<ref name=AMP09>{{cite journal |vauthors=Trojian TH, Lishnak TS, Heiman D |title=Epididymitis and orchitis: an overview |journal=Am Fam Physician |volume=79 |issue=7 |pages=583–7 |date=April 2009 |pmid=19378875 }}</ref>

====Chronic epididymitis====
[[File:Epididymal calcifications and cyst.jpg|thumb|[[Scrotal ultrasound]] showing calcifications and cysts in a case of chronic epididymis.]]
Chronic epididymitis is epididymitis that is present for more than 3 months. Chronic epididymitis is characterized by inflammation even when there is no [[infection]] present. Tests are needed to distinguish chronic epididymitis from a range of other disorders that can cause constant scrotal pain including [[testicular cancer]] (though this is often painless), enlarged scrotal veins ([[varicocele]]), calcifications,<ref>{{cite web|url=https://radiopaedia.org/articles/epididymal-calcification|title=Epididymal calcification|author=Matt A. Morgan and Yuranga Weerakkody|website=[[Radiopaedia]]|access-date=2018-05-21}}</ref> and a possible [[cyst]] within the epididymis. Some research has found that as much as 80% of visits to a urologist for scrotal pain are for chronic epididymitis.<ref name=kav>{{Cite book|title=Practical urology: essential principles and practice|last1=Kavoussi|first1=Parviz K.|last2=Costabile|first2=Raymond A.|editor1-last=Chapple|editor1-first=Christopher R.|editor2-last=Steers|editor2-first=William D.|year=2011|chapter=Disorders of scrotal contents: orchitis, epididimytis, testicular torsion, torsion of the appendages, and Fournier's gangrene|publisher=Springer-Verlag|place=London|chapter-url=https://books.google.com/books?id=A9m8TkdCUqEC&pg=PA315|isbn=978-1-84882-033-3}}</ref>{{rp|p.311}} As a further complication, the nerves in the scrotal area are closely connected to those of the abdomen, sometimes causing abdominal pain similar to a hernia (see [[referred pain]]).

Chronic epididymitis is most commonly associated with lower back pain, and the onset of pain often co-occurs with activity that stresses the low back (i.e., heavy lifting, long periods of car driving, poor posture while sitting, or any other activity that interferes with the normal curve of the [[lumbar lordosis]] region).<ref name=baran/>{{rp|p.237}}