Epididymitis may begin with a low-grade fever, chills, and a heavy sensation in the testicle. The testicle becomes more and more sensitive to pressure.

Other symptoms include:

• Blood in the semen
• Discharge from the urethra (the opening at the end of the penis)
• Discomfort in the lower abdomen or pelvis
• Fever
• Groin pain
• Lump in the testicle
• Pain during ejaculation
• Pain or burning during urination
• Painful scrotal swelling (epididymis is enlarged)
• Tender, swollen groin area on affected side
• Testicle pain that gets worse during a bowel movement

Physical examination shows a red, tender, and sometimes swollen lump (mass) on the affected side of the scrotum. Tenderness is usually in a small area of the testicle where the epididymis is attached.

There may be enlarged lymph nodes in the groin area (inguinal nodes), and a discharge from the penis. A rectal examination may show an enlarged or tender prostate.

These tests may be performed:

• Complete blood count (CBC)
• Doppler ultrasound
• Testicular scan (nuclear medicine scan)
• Urinalysis and culture (you may need to give several specimens, including initial stream, mid-stream, and after a prostate massage)
• Tests for chlamydia and gonorrhea

It is important to distinguish this condition from testicular torsion. Testicular torsion is an emergency and should be treated with surgery as soon as possible.