From the Guidelines
Treatment for epididymitis-orchitis should always involve empiric therapy with antibiotics, such as those effective against C. trachomatis or N. gonorrhoeae, to achieve microbiologic cure, improve signs and symptoms, prevent transmission, and decrease potential complications. According to the Centers for Disease Control and Prevention guidelines 1, empiric therapy is indicated before culture results are available. The goals of treatment include:
- Microbiologic cure of infection
- Improvement of signs and symptoms
- Prevention of transmission to others
- Decrease in potential complications, such as infertility or chronic pain
As an adjunct to therapy, the following supportive measures are recommended:
- Bed rest
- Scrotal elevation
- Analgesics, such as NSAIDs, until fever and local inflammation have subsided 1. It is essential to note that while the provided study is from 2002 1, its recommendations on empiric therapy and supportive measures remain relevant in the context of treating epididymitis-orchitis, prioritizing morbidity, mortality, and quality of life.
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 treatment for Epididymitis: Orchitis with doxycycline is:
- 100 mg, by mouth, twice a day for at least 10 days for both N. gonorrhoeae and C. trachomatis causes 2
From the Research
Treatment for Epididymitis: Orchitis
- The treatment for epididymitis and orchitis depends on the age of the patient and the likely causative organisms 3, 4.
- For sexually active males between 14 and 35 years of age, the most common pathogens are Neisseria gonorrhoeae and Chlamydia trachomatis, and the treatment of choice is a single intramuscular dose of ceftriaxone with 10 days of oral doxycycline 3, 4, 5.
- 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, 5.
- In men older than 35 years, epididymitis is usually caused by enteric bacteria, and levofloxacin or ofloxacin alone is sufficient to treat these infections 3.
- The British Association for Sexual Health and HIV (BASHH) UK guideline for the management of epididymo-orchitis recommends empirical treatment with ceftriaxone and doxycycline for sexually acquired epididymo-orchitis, and ofloxacin or doxycycline for non-gonococcal organisms 5.
- Recent advances in diagnostic techniques support a change in the management paradigm, and the choice of initial antibiotic regimen is empirical and based on the most likely causative pathogen 6.
Antibiotic Management
- The current treatment regimens for epididymitis remain empirical, although recent advances using modern diagnostic techniques support a change in the management paradigm 6.
- The use of advanced microbiology techniques and studies of current practice provide new insights that have challenged traditional management paradigms 6.
- Identification of specific pathogens and prescribing accuracy is dependent on the extent to which cases are investigated and is therefore variable 6.