From the Guidelines
Epididymitis should be treated with antibiotics, and the choice of antibiotic depends on the suspected cause, with doxycycline or azithromycin for sexually transmitted infections and fluoroquinolones for non-sexually transmitted bacterial infections, as recommended by the Centers for Disease Control and Prevention 1.
Causes and Treatment
Epididymitis is an inflammation of the epididymis, the coiled tube at the back of the testicle that stores and carries sperm. The condition typically results from bacterial infection spreading from the urethra or bladder, with common causes being sexually transmitted infections in younger men and urinary tract infections in older men.
- For sexually transmitted infections, doxycycline 100mg twice daily for 10 days or azithromycin 1g as a single dose may be prescribed.
- For non-sexually transmitted bacterial infections, fluoroquinolones like ciprofloxacin 500mg twice daily for 10 days are often used.
Pain Management and Prevention of Complications
Pain management is essential and includes rest, scrotal elevation, ice packs, and anti-inflammatory medications such as ibuprofen 400-600mg three times daily.
- Sexual abstinence is recommended until treatment is complete.
- If symptoms don't improve within 3 days of antibiotic therapy, further evaluation is necessary.
- Prompt treatment is important to prevent complications like abscess formation or reduced fertility, as emphasized in the 2002 guidelines for treatment of sexually transmitted diseases 1.
Partner Referral and Evaluation
Patients who have epididymitis that is known or suspected to be caused by N. gonorrhoeae or C. trachomatis should be instructed to refer sex partners for evaluation and treatment, as stated in the 1998 guidelines for treatment of sexually transmitted diseases 1.
- Sex partners of these patients should be referred if their contact with the index patient was within the 60 days preceding onset of symptoms in the patient.
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 epididymitis caused by N. gonorrhoeae or C. trachomatis is 100 mg, twice a day, for at least 10 days 2.
- Key points:
- The dosage is the same for both N. gonorrhoeae and C. trachomatis infections
- Treatment should be continued for at least 10 days
- The dose may be administered with food, including milk or carbonated beverage, as required.
From the Research
Definition and Causes of Epididymitis
- Epididymitis is the inflammation of the epididymis, commonly seen in the outpatient setting 3, 4, 5.
- The etiology and treatment of epididymitis are based on patient age and the likely causative organisms 3.
- In children younger than 14 years, reflux of urine into the ejaculatory ducts is considered the most common cause of epididymitis 3.
- In sexually active males 14 to 35 years of age, Neisseria gonorrhoeae and Chlamydia trachomatis are the most common pathogens 3, 4, 5, 6.
- In men older than 35 years, epididymitis is usually caused by enteric bacteria transported by reflux of urine into the ejaculatory ducts secondary to bladder outlet obstruction 3, 4.
Symptoms and Diagnosis of Epididymitis
- Epididymitis presents as the gradual onset of posterior scrotal pain that may be accompanied by urinary symptoms such as dysuria and urinary frequency 3.
- Physical findings include a swollen and tender epididymis with the testis in an anatomically normal position 3, 4, 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.
Treatment of Epididymitis
- The treatment of epididymitis is empirical and targets the most common pathogens 3, 4, 5, 7.
- In sexually active males 14 to 35 years of age, a single intramuscular dose of ceftriaxone with 10 days of oral doxycycline is the treatment of choice 3.
- In men who practice insertive anal intercourse, an enteric organism is also likely, and ceftriaxone with 10 days of oral levofloxacin or ofloxacin is the recommended treatment regimen 3.
- In men older than 35 years, levofloxacin or ofloxacin alone is sufficient to treat these infections 3.