What is the treatment for epididymitis?

From the Guidelines

The treatment for epididymitis should involve empiric therapy with antibiotics, pain management, and supportive measures, as indicated by the most recent guidelines 1. The goal of treatment is to achieve microbiologic cure of infection, improve signs and symptoms, prevent transmission to others, and decrease potential complications such as infertility or chronic pain.

Key Components of Treatment

• Antibiotics: a 10-14 day course is recommended, with common regimens including doxycycline 100mg twice daily or a fluoroquinolone like ciprofloxacin 500mg twice daily.
• Pain management: nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen 400-600mg three times daily, scrotal elevation with supportive underwear, and ice packs to reduce swelling.
• Supportive measures: bed rest is advised during the acute phase, and sexual abstinence until symptoms resolve completely, as well as adequate hydration and follow-up evaluation after treatment.

Considerations

• If sexually transmitted infections are suspected, ceftriaxone 250mg as a single intramuscular injection plus doxycycline may be used 1.
• In cases of non-bacterial epididymitis, anti-inflammatory medications are the primary treatment, as antibiotics would not be effective against viral or autoimmune causes.
• Testicular torsion, a surgical emergency, should be considered in all cases, especially among adolescents and in men without evidence of inflammation or infection 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 treatment for epididymitis caused by N. gonorrhoeae or C. trachomatis is doxycycline (PO) 100 mg, by mouth, twice a day for at least 10 days 2.

• The dosage is the same for both N. gonorrhoeae and C. trachomatis infections.
• The treatment duration is at least 10 days.

From the Research

Treatment of Epididymitis

The treatment of epididymitis depends on the patient's age and the likely causative organisms.

• 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.
• 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, epididymitis is usually caused by enteric bacteria, and levofloxacin or ofloxacin alone is sufficient to treat these infections 3, 4.
• The choice of antibiotic therapy may also depend on the presence of other conditions, such as bladder outlet obstruction, which can increase the risk of epididymitis 5.
• New therapies, including short-term therapy with fluoroquinolones or azalides, have been shown to be effective and easy to use, but the emergence of resistant strains must be monitored 6.
• Studies have also compared the efficacies of different antibiotics, such as ofloxacin, cefotaxime, and doxycycline, in the treatment of experimental epididymitis due to Escherichia coli in rats, and found that ofloxacin may be a very effective antimicrobial agent for the treatment of epididymitis due to E. coli 7.

Key Considerations

• The treatment of epididymitis should be guided by the patient's symptoms, physical findings, and laboratory results.
• It is essential to differentiate epididymitis from testicular torsion, which is a surgical emergency 5.
• Patients who are in severe pain or systemically unwell should be referred for analgesia, IV antibiotics, and hydration 5.