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Management . The etiology of epididymitis is often an ascending infection, secondary to reflux up the vas from the prostatic urethra, with resulting infection of the epididymis. In prepubertal boys and in men over the age of 35, bacterial urinary tract infection is a frequent cause of epididymitis, while in postpubertal patients under 35 years of age, Neisseria gonorrhoeae and Chlamydia trachomatis are common causes. 2 For this reason, urethral Gram's stain and culture should be obtained in order to direct treatment, and the patient's sexual partners should be treated if a sexually transmitted organism is identified.