On the Etiology of Epididymitis

Abstract

An exceptionally high frequency of acute epididymitis has been observed among military recruits in basic training. 28 soldiers presenting with an episode of acute tender swelling of the epididymis were evaluated. Average age was 21 years. 8 patients reported gonorrheal infection within the preceding 2 months. None had a recent history of trauma or prior operation, and no systemic symptoms or upper respiratory infections were noted. Acute tubular destruction with some micro abscesses in the tubules and some degree of interstitial inflammation was observed in 13 of the 24 cases for which laboratory specimens were adequate. Polymorphonuclear leukocytes were the predominant cells and some cases showed vasculitis. In 8 of the specimens with no tubular involvement, a chronic type of interstitial inflammation was noted. Lymphocytes were the main cells found in these cases. Testicular tissue was normal in 8 patients. Depressed spermatogenesis was noted in 20 patients, 9 of whom manifested inflammation. All viral and culture studies were negative. It was concluded that acute epididymitis is not caused by any culturable bacteria or virus; however, a chemical etiology is possible. Epididymitis appears to be mainly a disease of people who have extended periods of unaccumstomed strenuous physical exertion. Reflux up the vas deferens, induced by the physical strain of basic training, may be a major cause of the high rate of acute epididymitis observed among military recruits. Gonorrhea may also be a contributing factor. Antibiotic use is recommended in such cases to prevent secondary testicular atrophy.