What is the treatment for orchitis?

From the Guidelines

Treatment for orchitis should prioritize pain management and addressing the underlying cause, with antibiotics prescribed for bacterial origins, such as doxycycline (100mg twice daily for 10-14 days) or ciprofloxacin (500mg twice daily for 10-14 days), as recommended by the most recent guidelines 1.

Overview of Orchitis Treatment

The treatment approach for orchitis involves a combination of managing pain, reducing inflammation, and addressing the underlying cause of the infection. This can include the use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen for pain relief, bed rest, scrotal support, and applying cold packs to reduce swelling.

Antibiotic Treatment

For bacterial orchitis, antibiotic treatment is crucial. The choice of antibiotic depends on the suspected or confirmed causative pathogen.

• Doxycycline (100mg twice daily for 10-14 days) is a commonly recommended antibiotic for the treatment of bacterial orchitis, especially when Chlamydia trachomatis or Neisseria gonorrhoeae are suspected or confirmed 1.
• Ciprofloxacin (500mg twice daily for 10-14 days) may also be considered, particularly in cases where the causative pathogen is likely to be susceptible to this antibiotic.

Viral Orchitis

For viral orchitis, such as that caused by mumps, the treatment is primarily supportive, as antibiotics are ineffective against viral infections. Supportive care includes pain management with NSAIDs, rest, and scrotal support.

Importance of Prompt Treatment

Prompt treatment of orchitis is essential to prevent complications such as testicular atrophy, abscess formation, or fertility issues. Patients should seek immediate medical attention if they experience severe testicular pain, especially when accompanied by fever.

Diagnostic Considerations

The diagnosis of orchitis involves clinical evaluation and may include laboratory tests to identify the causative pathogen. Nucleic acid amplification tests (NAATs) are recommended for the diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae, the most common causes of epididymitis and orchitis in sexually active men under 35 years of age 1.

Key Points for Management

• Pain management with NSAIDs.
• Antibiotic treatment for bacterial causes, with doxycycline or ciprofloxacin being common choices.
• Supportive care for viral causes.
• Prompt medical attention for severe symptoms or fever.
• Completion of the full antibiotic course even if symptoms improve, to ensure complete eradication of the infection.

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 treatment for orchitis (specifically acute epididymo-orchitis) is doxycycline 100 mg, by mouth, twice a day for at least 10 days 2.

• The dosage is the same for orchitis caused by N. gonorrhoeae or C. trachomatis.
• It is essential to complete the full treatment course, even if symptoms improve before the end of the 10-day period.

From the Research

Treatment for Orchitis

The treatment for orchitis, also known as epididymo-orchitis (EO), depends on the underlying cause of the condition.

• For sexually acquired epididymo-orchitis, the first-line empirical treatment is ceftriaxone 1g intramuscularly and doxycycline 3.
• For patients with epididymo-orchitis probably due to non-gonococcal organisms, ofloxacin or doxycycline is recommended 3.
• If Mycoplasma genitalium is tested and identified, treatment should include an appropriate antibiotic, such as moxifloxacin 3.
• For enteric pathogens, ofloxacin and levofloxacin are recommended, especially in older patients, those who are not sexually active, or those with recent instrumentation or known abnormalities of the urinary tract 3.

Important Considerations

• Patients who are in severe pain or systemically unwell should be referred for analgesia, IV antibiotics, and hydration 4.
• It is essential to examine the patient for a palpable bladder and perform a digital rectal exam to check for bladder outflow obstruction, benign prostatic hyperplasia (BPH), prostate cancer, constipation, and prostatitis, which can also cause EO 4.
• Immunization is the best policy to avoid viral diseases such as mumps orchitis 5.

Diagnostic Tests

• Diagnostic tests, such as microscopy for gram-negative intracellular diplococci and urine dipstick for leucocytes and nitrites, can help identify the underlying cause of EO 3.
• A clinical care pathway has been produced to simplify the management of epididymo-orchitis, and a patient information leaflet has been developed 3.