Chronic Epididymitis - Please help !!!

[DamienSmith]

I'm male, 37 years old.    I'm suffering from moderate left testicular pain which started as dull pain on my left testicle 7 months back.   This pain radiates to my left penis, left left, left butt and left wrist.

All the STD tests came back negative - Chlamydia, Gonorrhea, Syphilis and Herpes.   Semen and Urine culture did not show any growth as well.   All these tests were taken several months after my last sexual activity.   I'm monogamous.

I don't see any visible changes in my genitals and no lumps or lesions.  No discharges and Urination is normal as well.

However during a recent color doppler ultra sound scrotal examination report came with the following impression
"Left Epididymitis with Bilateral Mild Hydrocoele and Left Inguinal Adenopathy"

No evidence of varicocoele.
Bilateral minimal hydrocoele.
Left inguinal discrete adenopathy noted.
Testis: Normal in shape, size and echotexture.   No evidence of focal lesion. Normal intra-testicular vascularity demonstrated."

After seeing the reports, my urologist was saying I have inflammation due to some infection, and started treating me Doxycycline 100mg twice a day for 10 days.  I took this antibiotics seriously without skipping.   However after completing the 10 days, I can see the pain more severe than in the past in my genitals.  

I'm not sure why the pain is not reducing.   I have no idea what these reports are, and what is this inflammation and infection could be.  

When I sit, it is hurting more than how my left testicle was hurting in the past.    I'm very much worried.   Can someone help me what I'm undergoing?

[DamienSmith]

I feel the pain actual pain originating on top of my testicle (backside) and the base of my penis (backside), the place where penis and testicle joins.   I'm able to roll my left testicle which doesn't cause any pain.   I'm thinking can this me more related to some injury or infection in the nerves in this region, rather than epididymitis?

Occasionally (once in a while) I'm  noticing these pains are shifting from left to right side.   The referred (related) pain in leg also shifts to right immediately along with the testicle pain,  and all the pain on the left side stops instantly.   Once the testicle pain moves to left side again, again all the referred pain comes back to left side.

[DamienSmith]

I missed writing the following section from my scrotal ultra sound test.

The size of the epididymis shown in the report:  
"Right epididymis: 0.9 x 0.6 cms
Left epididymis: 1.1 x 0.8 cms
Left epididymis is mildly bulky involving the head, body and tail. "

Though the swelling is mild, the mild accumulation of bilateral hydrocoele and Left inguinal discrete adenopathy makes my urologist think, it could be an infection.  

Tests taken on multiple times on semen culture, urine culture were always clear, and tests taken again multiple times for Syphilis, Gonorrhea, Chlamydia, Genital Herpes, and all their readings came back showing negligible values and negative as well.     This is making me think is there any other bacteria, virus or anything else which can't be found in testing?

I had very mild pain for a brief time in the same place (ie), behind my left testicle and base of the left penis 2.5 years back.   Is that the same pain came back strongly now (7 months back) and causing this inflammation?

[DamienSmith]

Thanks.   Any reason why the pain became worse while taking Doxycycline?   Now the pain is much reduced after I completed for all the 10 days prescribed.

I did check with my Urologist earlier about nerve block.   Since mild bilateral hydrocoele is present, he is saying it is not going to be effective.

Forgot to mention - the report was showing only "mild swelling" in the left epididymitis.  The measurement of the left epididymitis is showing only a slightly more when compared with the right epididymitis.

May be wierd.   I couldn't sleep last night just because I didn't have any pain.  My mind was constantly focused on my genitals, and was waiting or expecting to receive the signals of this pain from my geneitals.  However there was no pain whole night.   Much better after stopping Doxycycline.

I was tested for TB as well in epididymits which also came back as negative.

May be I injured it this region due to excessive cycling/workout?  Can injuries also  cause inguinal adenopathy and hydrocoele?  

I'm extremely worried.

[Dr J Singh]

Hello,
From the report, you are having a chronic infection of the epididymis and this is causing mild hydrocele and inguinal adenopathy( lymph node swelling due to infection). Chronic epididymitis is characterised by inflammation even when there is no infection present. Sometimes there may be compression of the nerves in the area which may cause persistent pain. We have to use antibiotics for a longer period of time and if it still persists then we can have cord block. This consists of an injection into the nerve that traces along the epididymis.

Last resort is of removing the epididymis. You consult your urologist and take the antibiotics or maybe some other antibiotics for a longer period of time.
I sincerely hope that helps. Take care.