From the Guidelines
Orchitis should be treated with empiric therapy before culture results are available to ensure microbiologic cure of infection, improvement of signs and symptoms, prevention of transmission to others, and a decrease in potential complications. The treatment approach depends on the cause of orchitis, which can be viral or bacterial. For bacterial orchitis, antibiotics are prescribed, while for viral orchitis, treatment focuses on symptom relief. According to the European Association of Urology guidelines on urological infections 1, acute epididymitis, which can involve the testis and scrotal skin, is predominantly caused by Enterobacterales, C. trachomatis, and Neisseria gonorrhoeae.
Some key points to consider in the management of orchitis include:
- Practicing safe sex to prevent sexually transmitted infections 1
- Completing prescribed antibiotic courses for urinary tract infections to prevent complications 1
- Receiving the MMR (measles, mumps, rubella) vaccine to prevent mumps-related orchitis
- Providing symptom relief with rest, scrotal support, cold packs, and pain medications like ibuprofen for viral orchitis
- Considering hospitalization for severe cases
It is essential to note that orchitis can sometimes be confused with testicular torsion, which is a surgical emergency, emphasizing the need for prompt medical attention 1. The Centers for Disease Control and Prevention also recommend bed rest, scrotal elevation, and analgesics as adjuncts to therapy until fever and local inflammation have subsided 1.
From the FDA Drug Label
Acute epididymo-orchitis caused by N. gonorrhoeae: 100 mg, by mouth, twice a day for at least 10 days. Acute epididymo-orchitis caused by C. trachomatis: 100 mg, by mouth, twice a day for at least 10 days The recommended dose of doxycycline for orchitis (specifically acute epididymo-orchitis) is 100 mg, by mouth, twice a day for at least 10 days 2.
- The treatment duration is at least 10 days.
- The dosage is the same for orchitis caused by N. gonorrhoeae or C. trachomatis.
From the Research
Definition and Causes of Orchitis
- Orchitis is defined as inflammation of the testis, which can be caused by an infectious agent 3, 4
- The main causative agents of orchitis are Chlamydia trachomatis and Neisseria gonorrhoeae in young adults, while in prepubertal children and adults older than 35 years, enterobacteria are the most common cause 3, 5
- Dissemination of the organism can occur via the bloodstream, particularly with viruses, or by direct spread from a focus in the epididymis 3, 4
Symptoms and Diagnosis of Orchitis
- Men with orchitis typically present with a gradual onset of scrotal pain and symptoms of lower urinary tract infection, including fever 5, 6
- Physical findings include a swollen, tender epididymis or testis located in the normal anatomic position with an intact ipsilateral cremasteric reflex 5
- Laboratory studies, including urethral Gram stain, urinalysis and culture, and polymerase chain reaction assay for C. trachomatis and N. gonorrhoeae, help guide therapy 5, 7
Treatment of Orchitis
- Initial outpatient therapy is empirical and targets the most common pathogens 5, 6
- When C. trachomatis and N. gonorrhoeae are suspected, ceftriaxone and doxycycline are recommended 5, 7
- When coliform bacteria are suspected, ofloxacin or levofloxacin is recommended 5, 6
- Treatment should be given for 3 weeks, and sexual partners should be evaluated and treated 3