Brief Answer:
Investigations / Medical / surgical management as may be needed.

Detailed Answer:
Hi.
Thanks for your query.
Read the history and understood your problem.

Epididymis by virtue of its typical anatomy is very resistant to get a permanent cure in some cases and can also indicate for some specific infection like tuberculosis, if you reside in an area where tuberculosis is present.

May I please know your area of residence / work / visit to countries where tuberculosis is known to occur?

May I also know your marriage status, if married - number of children or the want to have more children?

willingness to have excision of the diseased epididymis if no need to extend the family that is the family is complete?

Which side is affected epididymitis one or both?
What are your symptoms?

Let us get few things straight as per my knowledge:

-First of all stop icing or applying heat as this will not help and may cause more problems to the skin of the scrotum.

-you can continue Doxycyclin for 3 weeks to 3 months.

-Sex is not a taboo, in fact the regular ejaculation will facilitate the outflow of the sperms and the infected material out. You should have regular ejaculation by sex (with condom) / masturbation.

-Scrotal support.

I would suggest you the plan of investigations and treatment as per history of your age of 34 and 4 months of Chronic Epididymitis ::

-Continue Doxycyclin if you have taken a short course only.
-Can continue anti-inflammatory, but also take a PPI like pantoprazole to avoid acidity.
-Ultrasonography guided FNAC to see for tuberculosis or non-specific infection.
-Blood tests of CBC, ESR, Sugar, Quantiferon Gold test for Tuberculosis.
-X-ray of the chest.

-If there is a diagnosis of tuberculosis : Antitubercular treatment will resolve the problem.
-I do advise few of my patients to undergo Epididymectomy- excision of the diseases part if all the medical treatment fails, if the patient has completed his family ( Children ) and is willing to go for it. This is important to understand as once the diseased part is removed the semen will not have sperms coming from that particular area.

I have tried my best you to guide in full, I hope this would help you to come out of your problems. Please feel free to provide the information and ask for more if you need to.

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Brief Answer:
Take second opinion

Detailed Answer:
Hello.
Thanks for your feedback.
Florida has Tuberculosis cases, so I would request you to consult your Physician / new Urologist and make Him / Her aware of this possible diagnosis of Tubercular Epididymitis. TB is one of the reasons for Chronic Epididymitis. We In XXXXXXX take this as TB unless proved otherwise.

You may please continue on Doxycyclin.
A small bump on the anus can be a boil and it is better to get it diagnosed whether a small issue or something else.

Taking ''Second Opinion of another Urologist ' is always a good idea. Please discuss with Him the points I noted - He may help you better.
Heat / Ice gives you relief, continue if it help you; I meant to say two things- this is not a cure and mislead sometimes, Save the skin as it may get traumatized easily. Just be careful, I mean.

Yes, technically / physiologically- emptying has to help, the worsening in your case may be due to impaction of debris due to blockage of the tubules causing worsening. Try it out few times and see if it helps or increases pain / swelling.

Get all the relevant blood, urine, semen, ultrasonography and color doppler of abdomen and scrotum, tests for TB, X-ray chest and other tests done. If done please tel me the reports.

Your status will not allow us to consider surgery , so out of question at the moment and need for correct diagnosis and proper treatment.

I do not think Mag Sulph, probiotic beta blocker helps in Chronic cases like this one. Yet I shall review again and will let you know if it helps.

One of the best clinical diagnosis tests - you may try to do or your Doctor can ::
Beaded appearance of the vas deferens and epididymis. If you palpate the spermatic cord and the epididymis, you feel this as a beaded XXXXXXX (albeit of a small size).

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Brief Answer:
post the report please.

Detailed Answer:
Please post the report attached to this query..
Does any report or Doctor's opinion says this is chronic epididymitis ?

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