MLB Weekly Digest September 3rd Edition - NGSC Sports
Swollen And Painful Crown Jewels
Dear Dr. G,
I am a fit and healthy man in my early thirties.
I recently encountered some issues with my testicles, and really hope you can help.
I started noticing slight discomfort in my left scrotum a fortnight ago, when urinating.
Over the last few days, it has swollen to double its size and the pain has caused much concern.
It is also painful every time I urinate and have a mild fever.
I think I may have caught some infection somewhere, but am just really puzzled how I got it.
I am too embarrassed to tell anyone about the "lopsided" painful crown jewel.
Can you tell me what can possibly be wrong with my testicles?
Is it normal to have the swelling of the testicles progressing so fast?
Can the testicles really get infected?
What are the possible causes of swellings in the crown jewels?
The swelling of the testicle tends to get bigger and uncomfortable. Is it a bad sign?
I am worried and embarrassed about someone "fondling" my balls, if I go to the doctors.
Can you please help me to clarify the risk of my swollen crown jewels?
Regards,
Painful swollen Pete
The gradual swelling of the testicles tends to be benign in nature. Benign swellings of the testicles including varicoceles, hydrocele, epididymal cysts and hernia, develop slowly and most of these swellings are painless. Rapid and painful testicular swelling is likely to be caused by the infection known as epididymal-orchitis.
This is a medical condition characterised by the inflammation of the testis and the associated curved structure at the back of the testicle, known as epididymis.
Epididymal orchitis in younger men typically develops over the course of several days, resulting in painful swelling of one testicle.
This is often associated with painful frequent urination and urethral discharge.
Typical causes of epididymal orchitis in sexually young men are sexual in nature. Common sexually transmitted infections such as gonorrhea and chlamydia backtrack from the urethral into the testicles, following unprotected sexual intercourse.
Infections of the testicles in older men are usually caused by enteric bacteria such as E. Coli. Such infection arises from dehydration or bladder outflow obstruction due to prostate enlargement.
Benign Prostatic Hyperplasia is common in older men due to incomplete bladder emptying after urination. The residual urine tends to get infected in the bladder, and the backwards infection of the testicle occurs when the cystitis is not treated early enough.
Non-bacterial or non-infective epididymal orchitis can also occur. Mumps is a viral illness caused by paramyxovirus that is well-known to be associated with painful infections of the testicle.
Non-infectious causes of testicle inflammation can also occur when sterile urine refluxed through the ejaculatory ducts causing epididymal orchitis, without the pathogens.
Symptoms of epididymal orchitis are usually sufficient in determining the diagnosis.
These include rapid painful swellings of the testicle associated with redness of the scrotum. Palpation of the testicle reveals a significant disparity in sizes and the scrotal pain is also relieved by the elevation of the affected testis.
For men who are squeamish about scrotal examinations, there is painless ultrasound imaging to determine the diagnosis. Complications such as chronic epididymal orchitis and abscess can also be detected by ultrasound scans.
Both acute and chronic forms of epididymal orchitis can be fully treated by antibiotics.
The treatment of choice for sexually transmitted bacteria are ceftriaxone and azithromycin.
Enteric bacterial infections in older men are usually sensitive to antibiotics such as Ciprofloxcillin and Augmentin.
The complete resolution of the infection is achievable with an adequate duration of antibiotics. Late treatment of the infection can be associated with infertility or scrotal abscess, which may result in surgical removal of the testicle.
What's The Difference Between Chlamydia And Gonorrhea?
People of any anatomy can contract chlamydia or gonorrhea and never develop any symptoms. When symptoms do occur, there are a few telltale signs differentiating the two conditions.
Chlamydia and gonorrhea are both sexually transmitted infections (STIs) caused by bacteria. They can be contracted through oral, genital, or anal sex.
The symptoms of these two STIs overlap, so if you have one of these conditions, it's sometimes hard to be sure which one it is without having a diagnostic test at a doctor's office.
Some people with chlamydia or gonorrhea may have no symptoms. But when symptoms occur, there are some similarities, such as an abnormal, bad-smelling discharge from the penis or vagina, or a burning feeling when you pee.
Chlamydia is more common than gonorrhea. According to a 2017 report, over 1.7 million cases of chlamydia were reported in the United States, while just over 550,000 cases of gonorrhea were documented.
Read on to learn about how these two STIs are different, how they're similar, and how you can reduce your risk for these infections.
People of any anatomy can contract chlamydia or gonorrhea and never develop any symptoms.
With chlamydia, symptoms may not appear for a few weeks after you've contracted the infection. And with gonorrhea, people who have female anatomy may never experience any symptoms at all or may only show mild symptoms, while people who have male anatomy are more likely to have symptoms that are more severe.
A couple of the most telltale symptoms of these STIs overlap between the two, such as:
With both gonorrhea and chlamydia, people with male anatomy may also experience abnormal swelling in their testicles and scrotum, and pain when they ejaculate.
You may also develop symptoms that affect your throat if you engage in oral sex with someone who has one of these conditions. This can cause mouth and throat symptoms, including sore throat and a cough.
Chlamydia symptomsWith chlamydia, people with female anatomy may experience more severe symptoms if the infection moves upward to the uterus and fallopian tubes. This can cause pelvic inflammatory disease (PID).
PID can cause symptoms such as:
Seek emergency medical help if you think you may have PID.
Gonorrhea symptomsWith gonorrhea, you may also notice rectal symptoms like itching, soreness, and pain when you defecate.
People with female anatomy may also notice heavier bleeding during their periods and pain during sex.
Both conditions are caused by an overgrowth of bacteria. Chlamydia is caused by an overgrowth of the bacteria Chlamydia trachomatis.
Gonorrhea is caused by an overgrowth of bacteria called Neisseria gonorrhoeae.
Both STIs are caused by bacterial infections that are transmitted through unprotected sexual contact, meaning sex without using a condom, dental dam, or another protective barrier between you and your partner during vaginal, anal, or oral sex.
It's also possible to contract the infection through sexual contact that doesn't involve penetration. For example, if your genitals come into contact with the genitals of someone who's contracted the infection, it's possible to develop the condition.
Both STIs can also be contracted through protected sex with a condom or other barrier if you don't use protection properly, or if the barrier breaks.
Either STI can be contracted even if you aren't showing visible symptoms. Both STIs can also be transmitted to a child at birth if the mother has either condition.
You're at increased risk for developing these and other STIs if you:
Sexual assault can also increase your risk of both chlamydia or gonorrhea.
Get tested for STIs as soon as possible if you've recently been forced to have non-consensual oral, genital, or anal sex. If you're in the United States, you can also call the Rape, Abuse, and Incest National Network (RAINN) for support from people who can help without revealing any of your personal information or details of your experience.
Both STIs can be diagnosed using similar diagnostic methods. Your doctor may use one or more of these tests to ensure that the diagnosis is accurate and that the right treatment is given:
Both STIs are curable and can be treated with antibiotics, but you're more likely to contract the infection again if you've had either STI before.
Treatment for chlamydiaChlamydia is usually treated with a dose of azithromycin (Zithromax, Z-Pak) taken either all at once or over a period of a week or so (typically about five days).
Chlamydia can also be treated with doxycycline (Oracea, Monodox). This antibiotic is usually given as a twice-daily oral tablet that you need to take for about a week.
Follow your doctor's dosage instructions carefully. It's important to take the full dosage for the prescribed number of days so that the antibiotics can clear the infection. Not completing the round of antibiotics can cause you to become resistant to that antibiotic. This can be dangerous if you contract the infection again.
If you're experiencing symptoms, they should begin to fade a few days after you start treatment.
Avoid sex until your doctor tells you that the infection has fully been cleared by the antibiotics. It can take two weeks or more for the infection to clear up, and during that time, you can still transmit the infection.
Treatment for gonorrheaYour doctor will likely prescribe ceftriaxone (Rocephin) in the form of an injection into your buttock.
The CDC previously recommended ceftriaxone plus azithromycin, but the guidelines were changed because the bacteria causing gonorrhea are becoming increasingly resistant to azithromycin.
Using both antibiotics helps clear the infection better than using only one treatment alone.
As with chlamydia, don't have sex until the infection clears, and be sure to take your entire dose.
Gonorrhea is more likely than chlamydia to become resistant to antibiotics. If you contract the infection with a resistant strain, you'll need treatment with alternative antibiotics, which your doctor will recommend.
Some complications of these STIs can happen to anyone. Others are unique to each sex due to differences in sexual anatomy.
Gonorrhea has more severe possible complications and is more likely to cause long-term problems like infertility.
In both males and femalesComplications that may be seen in anyone include:
The only way that you can completely prevent yourself from catching chlamydia, gonorrhea, or another STI is by abstaining from sexual activity.
But there are also plenty of ways you can reduce your risk of contracting or transmitting these infections:
Both chlamydia and gonorrhea can be transmitted in the same ways, and both can easily be treated using antibiotics.
Both are also preventable if you take precautions during sex, such as using protection and limiting the number of people you have unsafe sex with at any given time.
Regular STI testing, for both you and your sexual partners, can also help reduce the risk of transmitting an infection if you or a sexual partner develop an STI.
If you suspect an STI or have been diagnosed with one, stop all sexual activity and get treatment as soon as possible. If you're diagnosed, tell anyone you've had sex with to get tested just in case.
Causes And Treatment Of Chronic Prostatitis
Chronic prostatitis refers to pain in the prostate that lasts at least 3 months. It happens due to inflammation of the prostate. It can affect sexual function and the ability to urinate. Possible causes include bacterial infections and damage to the pelvic nerves.
Acute prostatitis is an infection or pain in the prostate gland lasting less than 3 months.
In this article, we look at the causes and symptoms of chronic prostatitis. We also cover diagnosis, treatment, and home and alternative remedies.
The prostate is a small gland that forms part of the lower urinary tract in males. It sits in front of the rectum, under the bladder, and surrounds the urethra, the tube that carries urine and semen out through the penis.
The prostate is part of the male reproductive system and produces one of the fluids that make up semen. The muscles of this gland also help push semen into the urethra during ejaculation.
Due to its location and function, prostate problems can affect urination as well as sexual function.
Prostatitis is an inflammation of the prostate that can often be painful. It can be chronic or acute.
Chronic prostatitis develops gradually and can last for months or even years. Doctors consider prostatitis to be chronic if symptoms continue for 3 months or more. It may not respond well to initial treatment.
Acute prostatitis appears suddenly and is temporary. It may only last a few days or weeks and often responds well to treatment. If it persists, it may become chronic prostatitis.
Prostatitis is the leading cause of urinary tract issues for men under 50 years of age, and the third most common urinary tract issue for men over 50.
What other prostate problems are there?
Prostatitis can be bacterial or nonbacterial.
Chronic bacterial prostatitisA bacterial infection of the prostate causes chronic bacterial prostatitis.
It can result from:
The symptoms of chronic bacterial prostatitis are often less severe than those of acute bacterial prostatitis. A person who has previously had an acute infection might notice that their symptoms get better but do not go away.
Chronic non-bacterial prostatitis, or chronic pelvic pain syndromeThis is a non-bacterial form of prostatitis that can have many causes and is harder to treat.
It can occur when:
The main symptom of chronic prostatitis is genital or pelvic pain. For some people, the pain feels like a gnawing ache. For others, it is intense and sharp. The pain may come and go or always be present.
Other symptoms of chronic prostatitis include:
Anyone with these symptoms should see a doctor as soon as possible. They may be a sign of another health condition that needs urgent attention. Untreated, they could lead to complications.
Is there a link between prostatitis and prostate cancer?
People with symptoms of prostatitis should see a doctor. If a bacterial infection is present, seeking medical help as soon as possible can help prevent it spreading.
To diagnose prostatitis, a doctor will most likely:
During a rectal exam, a doctor inserts a finger into the person's rectum to check the prostate for swelling and inflammation. They may also look for signs of infection, such as discharge from the penis or swollen lymph nodes.
A doctor may recommend antibiotics if they suspect the problem is due to a bacterial infection.
They may recommend further tests if symptoms do not improve with antibiotics or there are no signs of an infection.
Options include:
What types of physical examination are there?
Treatment for chronic prostatitis will depend on the cause.
People with chronic prostatitis due to a bacterial infection or recurrent infections may need antibiotics for up to 6 months.
Other treatment options include:
Various home and alternative treatments may support medical treatment for chronic prostatitis.
Kegel exercisesKegel exercises, also known as pelvic floor exercises, can help improve urination difficulties in people with chronic prostatitis. The exercises work by strengthening the muscles around the bladder and penis.
To do these exercises:
It may take a few months before a person notices the results.
What are Kegel exercises for males?
Other remediesOther home and alternative remedies that may provide symptom relief for people with chronic prostatitis include:
People should always speak with a doctor before trying a new or alternative remedy, as some options may interact with other medications or may be unsafe for some people.
Can saw palmetto help reduce an enlarged prostate gland?
Here are some questions people often ask about prostatitis.
What are some common signs and symptoms of prostatitis?Common signs of prostatitis include:
A doctor will prescribe antibiotics if a bacterial infection appears to be present. If tests show another cause, they will prescribe treatment appropriately. Some home and alternative remedies may help support medical treatment.
Does prostatitis go away?Acute prostatitis may go away with antibiotics, but it may return or linger and become chronic prostatitis. If prostatitis does not go away with initial treatment, a person should speak with their doctor. They will help find a solution.
Chronic prostatitis is a long-term condition that can cause pain and difficulties with urination. Anyone with symptoms of prostatitis should see a doctor.
Treatment depends on the cause and symptoms. If an infection is present, a person may need antibiotics. Kegel exercises and certain home and alternative remedies may also help relieve symptoms.
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