Time of Onset. Being a complication of posterior urethritis, which does not develop at once after infection, the inflammation of the epididymis and testicle does not, as a rule, develop until from two to five weeks after the acute gonorrhoea. If instruments are passed in the acute stage, some of the gonorrhceal pus is liable to be carried down mechanically to the posterior urethra and an epididymitis may then develop within a few days. Occasionally these symptoms are not seen until the lapse of one, two, or three years after the beginning of the disease.
Symptoms. The most constant symptom is a severe and sudden pain which attacks one testicle, the agony being so great and the sensations so depressing that the patient's morale is upset, and he does not fail to realize that a serious complication has befallen him.
There is usually a general systemic reaction, with fever, chills, constipation, furred tongue, hot skin, and a rapid pulse, with frequency of urination and, occasionally, bloody pollutions. With the onset of an epididymitis the urethral discharge usually ceases.
Some patients continue about their usual duties for a day or so before they are forced to give up; but, as a rule, sufferers with epididymitis or orchitis voluntarily assume the recumbent position within twenty four hours. The physician will probably find the patient lying on his back, with the leg on the affected side drawn up, and with the scrotum supported either by the patient's hand or by a soft cushion.
Pressure on the scrotum causes agonizing pain, and even when the sufferer lies perfectly still the torture is severe and nauseating. In some cases the inflammation also affects the vas deferens.
Not infrequently the inflammation also attacks the thin serous envelope which lines the interior of the scrotum the tunica vaginalis causing it to pour out a serous effusion which may so distend the affected compartment that the testicle can no longer be felt. This effusion is called an acute hydrocele, and the hydrocele fluid, unless drawn off by the surgical operation of "tapping", wttl remain indefinitely before it is absorbed.
The changes just described usually come on rapidly and attain their greatest intensity within from two to five days, though efficient treatment does much to modify the severity of the symptoms.
Within a few days the inflammatory symptoms subside, as a rule, and the patient resumes his ordinary mode of life; but residua, or left over effects, are practically sure to persist. Sometimes there is a fatal peritonitis as a consequence of gonorrhoea! invasion of the seminiferous tubes, though usually the inflammation is localized to only a portion of the abdominal viscera.
Termination and Results. A complete cure is rare. After a time the effused fluid is absorbed, all perceptible swelling disappears, and the patient, suffering little or no pain or inconvenience, regards himself as well. But some induration, or hardening, remains in the globus major of the epididymis, and the skilled physician can usually feel a knot of about the size of a pea even for months or years after all symptoms have subsided. If there has been a severe gonorrhceal inflammation in the vas deferens, one can usually, for an indefinite time thereafter, trace that structure as a firm, dense cord running upward to the external abdominal ring. As might be expected, the inflammation is exceedingly liable to permanently seal up the minute calibre of the seminiferous tubes with a dense scar tissue, throwing the affected side completely out of service; while if both sides are obstructed, there is of course complete sterility. The individual may thereafter fully enjoy copulation and have a discharge which he thinks is true semen; but in reality he is sterile, the ejaculation being absolutely wanting in spermatozoa.
With every repeated infection of gonorrhoea there is almost sure to be an exacerbation of the epididymitis, with increased risk of sterility. Sometimes the testicle breaks down into pus, suppurates, and becomes an abscess, which discharges its necrosed elements through an external vent. The scrotum of the side so affected may also be destroyed, leaving an unsightly deformity. If a man is so unfortunate as to have a syphilitic taint, that disease will probably attack the testicle, if inflamed with gonorrhceal virus, with terrible intensity.