From the Guidelines
The recommended treatment for sexually transmitted acute epididymitis is a combination of antibiotics targeting common causative organisms like Chlamydia trachomatis and Neisseria gonorrhoeae, with the first-line regimen consisting of ceftriaxone 500 mg intramuscularly as a single dose plus doxycycline 100 mg orally twice daily for 10 days. This approach is based on the most recent and highest quality study available, which emphasizes the importance of empiric therapy before culture results are available to achieve microbiologic cure of infection, improve signs and symptoms, and prevent transmission to others 1.
Key Considerations
- The treatment should provide broad coverage against the most common sexually transmitted pathogens while reducing inflammation and pain.
- Symptomatic relief measures should include bed rest, scrotal elevation, analgesics like ibuprofen 400-600 mg every 6-8 hours, and ice packs to reduce inflammation.
- Sexual partners from the previous 60 days should be evaluated and treated to prevent reinfection, as treating sex partners is crucial in preventing reinfection 1.
- Patients should abstain from sexual activity until treatment is complete and symptoms have resolved.
Alternative Regimens
For patients allergic to cephalosporins, alternative regimens include azithromycin 1 gram orally as a single dose plus a fluoroquinolone such as levofloxacin 500 mg orally once daily for 10 days.
Prevention of Complications
Treatment should begin promptly to prevent complications such as abscess formation, testicular infarction, or chronic epididymitis which could lead to infertility, as emphasized in guidelines for the treatment of 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 recommended treatment for sexually transmitted acute epididymitis is doxycycline 100 mg, by mouth, twice a day for at least 10 days 2.
- For N. gonorrhoeae and C. trachomatis infections, the same dosage is recommended.
- The treatment should be continued for at least 10 days.
From the Research
Treatment for Sexually Transmitted Acute Epididymitis
The recommended treatment for sexually transmitted acute epididymitis is based on the causative pathogen and patient age.
- For sexually active males aged 14 to 35 years, the most common pathogens are Neisseria gonorrhoeae and Chlamydia trachomatis 3.
- The treatment of choice in this age group is a single intramuscular dose of ceftriaxone with 10 days of oral doxycycline 3.
- According to the 2020 CDC Gonorrhea Treatment Recommendations, a single 500 mg IM dose of ceftriaxone is recommended for treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea 4.
- If chlamydial infection has not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended 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.
Considerations for Treatment
- The choice of antibiotic therapy should be based on the suspected or confirmed causative pathogen and local resistance patterns 6.
- Patients with acute epididymitis should receive appropriate diagnostics and antimicrobial therapy for safe conservative management 6.
- The current guideline recommendations on empirical antimicrobial therapy are adequate, but patients with acute epididymitis should be referred to local Genitourinary medicine services for contact-tracing and treatment of their sexual partners 7.