What is the common cause of epididymitis in patients older than 40 years old?

Epididymitis in patients older than 40 years is frequently attributed to infections stemming from urinary tract issues, particularly involving gram-negative rods. In this demographic, the most common pathogens arise from infections related to urinary tract infections (UTIs) or prostatitis.

The underlying reason for this trend is the higher prevalence of urinary tract conditions in older patients, often associated with rectal infections or urinary retention, which may serve as a source for these bacteria. Organisms like Escherichia coli and other gram-negative rods are typical culprits in such infections, leading to inflammation of the epididymis and presenting with classic symptoms such as scrotal pain and tenderness.

In contrast, the other options primarily involve pathogens that are more closely associated with sexually transmitted infections (STIs), which are less likely to be the predominant cause of epididymitis in this age group. Gonorrhea and Chlamydia are more commonly responsible for epididymitis in younger males, particularly under the age of 35, due to increased sexual activity and risk of STIs. Similarly, while Coxsackie B virus can cause viral epidemics of viral infections and may result in orchitis, it is not a usual cause of epididym