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.
2) Irreversible adaptation to sperm competition . It has been suggested that the ancestor of the boreoeutherian mammals was a small mammal that required very large testes (perhaps rather like those of a hamster ) for sperm competition and thus had to place its testes outside the body.  This led to enzymes involved in spermatogenesis, spermatogenic DNA polymerase beta and recombinase activities evolving a unique temperature optimum, slightly less than core body temperature. When the boreoeutherian mammals then diversified into forms that were larger and/or did not require intense sperm competition they still produced enzymes that operated best at cooler temperatures and had to keep their testes outside the body. This position is made less parsimonious by the fact that the kangaroo , a non-boreoeutherian mammal, has external testicles. The ancestors of kangaroos might, separately from boreotherian mammals, have also been subject to heavy sperm competition and thus developed external testes, however, kangaroo external testes are suggestive of a possible adaptive function for external testes in large animals.