From the Guidelines
The recommended treatment for epididymitis is a combination of antibiotics, with ceftriaxone 1000 mg i.m. or i.v. plus a course of an antibiotic active against Chlamydia trachomatis, and supportive measures such as bed rest, scrotal elevation, and nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation. The treatment approach depends on the suspected cause, with gonorrhoea likely or unlikely guiding the choice of antibiotics 1. For acute epididymitis likely caused by sexually transmitted infections, the European Association of Urology guidelines suggest a single antibiotic or a combination of two antibiotics active against Chlamydia trachomatis and Enterobacterales, with consideration of parenteral therapy if the infection is severe 1.
Key considerations in the treatment of epididymitis include:
- Prompt initiation of therapy to prevent complications such as chronic epididymitis, abscess formation, or infertility
- Evaluation and treatment of sexual partners if a sexually transmitted infection is confirmed
- Use of supportive measures such as bed rest, scrotal elevation, and NSAIDs to manage pain and inflammation
- Consideration of urological consultation if an abscess forms or symptoms persist despite appropriate antibiotics
The most recent guidelines from the European Association of Urology provide a diagnosis and treatment algorithm for epididymitis, emphasizing the importance of clinical assessment, laboratory tests, and imaging studies in guiding treatment decisions 1. Overall, the goal of treatment is to achieve microbiologic cure, improve signs and symptoms, prevent transmission to others, and decrease the risk of potential complications 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 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 should be continued for at least 10 days.
From the Research
Treatment for Epididymitis
The recommended treatment for epididymitis varies based 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, 5, 6.
- 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, 5.
Antimicrobial Therapy
Antimicrobial agents are the mainstay of therapy for epididymitis, and the choice of antibiotic depends on the suspected pathogen.
- For Chlamydia trachomatis and Neisseria gonorrhoeae, ceftriaxone and doxycycline are recommended 3, 4, 5, 6.
- For coliform bacteria, ofloxacin or levofloxacin is recommended 3, 4.
Supportive Measures
Supportive measures, such as rest, scrotal elevation, and analgesics, may also be necessary to manage symptoms and reduce discomfort 7.