What is the immediate treatment for a patient presenting with orchitis (inflammation of the testis)?

From the Guidelines

The immediate treatment for orchitis involves pain management with NSAIDs, scrotal support, and elevation to reduce discomfort, along with empiric antibiotic therapy for bacterial causes, as recommended by the most recent guidelines 1.

Key Considerations

• Pain management is crucial, and NSAIDs such as ibuprofen (400-800 mg every 6-8 hours) or naproxen (500 mg twice daily) can be used to alleviate discomfort.
• Scrotal support and elevation can help reduce swelling and pain.
• For bacterial orchitis, empiric antibiotic therapy should be initiated promptly, typically with fluoroquinolones like ciprofloxacin (500 mg twice daily for 10-14 days) or trimethoprim-sulfamethoxazole (160/800 mg twice daily for 10-14 days), as suggested by recent studies 1.
• If mumps orchitis is suspected, treatment is primarily supportive, as antibiotics are ineffective against viral causes.
• Bed rest is recommended during the acute phase, and adequate hydration should be maintained.
• Severe cases may require hospitalization for intravenous antibiotics and pain control, as indicated by older guidelines 1.

Diagnostic Approach

• Ultrasound (US) is the established first-line imaging modality for acute scrotal disease, and can be used to diagnose most scrotal disorders when combined with clinical history and physical examination, as stated in recent updates 1.
• US findings in patients with epididymitis include an enlarged and hypoechoic epididymis due to edema, reactive hydroceles, and scrotal wall thickening, with increased blood flow corresponding to hyperemia on color Doppler imaging.
• The epididymis is the organ primarily involved in epididymoorchitis, with orchitis developing in 20% to 40% due to direct retrograde spread of infection, as noted in recent studies 1.

Prevention of Complications

• Prompt treatment is essential to prevent complications such as testicular atrophy, abscess formation, or infertility.
• Patients should be advised to abstain from sexual activity until symptoms resolve, and if sexually transmitted infection is suspected, partners should be evaluated and treated as well, as recommended by guidelines on sexually transmitted diseases 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 immediate treatment for a patient presenting with orchitis (inflammation of the testis) is doxycycline 100 mg, by mouth, twice a day for at least 10 days.

• The treatment is the same for orchitis caused by N. gonorrhoeae or C. trachomatis. 2

From the Research

Immediate Treatment for Orchitis

The immediate treatment for a patient presenting with orchitis (inflammation of the testis) depends on the underlying cause of the condition.

• For patients with suspected sexually transmitted infection (STI) as the cause of orchitis, particularly in younger men, the treatment may involve antibiotics such as ceftriaxone and doxycycline 3, 4.
• In cases where coliform bacteria are suspected, such as in older men, ofloxacin or levofloxacin may be recommended 4.
• It is crucial to differentiate orchitis from testicular torsion, a surgical emergency that requires immediate attention 3, 4.
• Patients who are in severe pain or systemically unwell should be referred for analgesia, IV antibiotics, and hydration 3.

Antibiotic Treatment

The choice of antibiotic treatment is guided by the suspected pathogen and may include:

• Ceftriaxone and azithromycin for gonococcal infections 5, 6.
• Doxycycline for chlamydial infections 4, 6.
• Fluoroquinolones, such as ofloxacin or levofloxacin, for infections caused by coliform bacteria 4.

Special Considerations

• Patients with a history of cephalosporin allergy may require alternative treatments, although options are limited 6.
• Pregnant women with gonococcal infections should be treated with the recommended dual therapy of ceftriaxone and azithromycin 5.
• Patients with indwelling urethral catheters are at high risk of multiple drug resistance and should be treated empirically with both a fluoroquinolone and a third-generation cephalosporin until antimicrobial susceptibility testing has been completed 7.