What is the most common pathogen that causes epididymitis in men over 35 years old?

The most common pathogen that causes epididymitis in men over 35 years old is Escherichia coli. This is primarily due to the fact that in this age group, the etiology of epididymitis often shifts from sexually transmitted infections to urinary tract pathogens, with E. coli being a typical organism involved.

In younger men, sexually transmitted infections such as Neisseria gonorrhoeae and Chlamydia trachomatis are the predominant causes of epididymitis, primarily due to their higher levels of sexual activity and risk factors associated with STIs. Mycoplasma genitalium is also considered a sexually transmitted pathogen, but it is less commonly reported in this age group compared to E. coli.

As men age, underlying conditions or urinary issues, such as benign prostatic hyperplasia, can lead to urinary retention, which increases the risk of urinary tract infections. Thus, E. coli, a common inhabitant of the intestinal flora that can translocate to the urinary tract, becomes the primary pathogen associated with epididymitis in older males.