Epididymoorchitis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: José Eduardo Riceto Loyola Junior, M.D.[2]; Dima Nimri, M.D. [3]

Overview

Management of epididymoorchitis consists mainly of conservative measures, including bed rest and limitation of physical activity, use of cold packs, analgesia and non-steroidal anti-inflammatory drugs (NSAIDs). In addition, appropriate antibiotic therapy should be initiated if the cause of epididymoorchitis is bacterial. All men with acute epididymitis should be tested for HIV and syphilis.

Medical Therapy

If acute epididymitis is most likely caused by chlamydia or gonorrhea

• Preferred regimen: Ceftriaxone 500mg IM single dose PLUS doxycycline 100mg PO bid for 10 days.

If acute epididymitis most likely caused by chlamydia, gonorrhea, or enteric organisms (men who practice insertive anal sex)

• Preferred regimen: Ceftriaxone 500mg IM single dose PLUS levofloxacin 500mg PO qd for 10 days.

If acute epididymitis most likely caused by enteric organisms only

• Occurs in patients who have been through prostate biopsy, vasectomy, and other urinary tract instrumentation procedures;
• Preferred regimen: Levofloxacin 500mg PO qd for 10 days.
  • If patient weights more than 150kg - give ceftriaxone 1gr IM single dose.

If etiology is likely viral

Antibiotics are not necessary if the underlying etiology is likely viral such as mumps orchitis or other viral epididymoorchitis. Management of epididymoorchitis consists mainly of conservative measures, including:

• Bed rest and limitation of physical activity;
• Scrotal elevation;
• Use of cold packs
• Analgesia
• Non-steroidal anti-inflammatory drugs (NSAIDs)
  

Alarm signs

• Severe pain or fever suggests other diagnoses (e.g., torsion, testicular infarction, abscess, or necrotizing fasciitis);
• Patients that are unable to comply to antibiotic treatment;
• Age;
• History of diabetes;
• Elevated C-reactive protein.

These may indicate higher severity and indicate hospitalization.

Management of partners

• Patients should be told to refer all sex partners during the previous 60 days before symptom onset for evaluation, testing, and presumptive treatment.
• If the last sexual intercourse was >60 days before onset of symptoms or diagnosis: most recent sex partner should be evaluated and treated.
• Abstain from sexual intercourse until symptoms have resolved (partners included).

HIV infection

• If uncomplicated acute epididymitis, HIV patients should be equally treated;
• Other etiologic agents have been implicated among HIV patients such as: CMV, salmonella, toxoplasmosis, U. urealyticum, Corynebacterium species, Mycoplasma species, and Mima polymorpha.