From the Guidelines
The treatment for epididymitis should involve empiric therapy with antibiotics, pain management, and supportive care, as indicated by the most recent guidelines. 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 1.
Key Components of Treatment
- Antibiotics: The choice of antibiotics depends on the likely cause of epididymitis, with ceftriaxone and doxycycline commonly prescribed for sexually transmitted infections, and fluoroquinolones like levofloxacin or ciprofloxacin for non-sexually transmitted cases.
- Pain management: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are recommended to reduce pain and inflammation.
- Supportive care: Bed rest, scrotal elevation, and application of cold packs can help reduce swelling and alleviate symptoms.
Adjunctive Measures
- Sexual abstinence is recommended until treatment is complete to prevent transmission to others.
- Urological consultation may be necessary if an abscess forms or symptoms persist despite appropriate antibiotic therapy.
The most recent guidelines from 2002 emphasize the importance of empiric therapy before culture results are available, highlighting the need for prompt treatment to prevent complications and improve outcomes 1. While earlier guidelines from 1998 also support empiric therapy, the 2002 guidelines provide more comprehensive recommendations for treatment and management 1. Therefore, the treatment approach should prioritize the most recent and highest-quality evidence, focusing on empiric antibiotic therapy, pain management, and supportive care to optimize outcomes for patients with epididymitis.
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 should be continued for at least 10 days.
From the Research
Treatment of Epididymitis
The treatment for epididymitis varies based on the patient's age and the likely causative organisms.
- For sexually active males aged 14 to 35 years, 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.
- 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.
- Other studies also recommend the use of quinolones, such as ciprofloxacin, as a first-line antibiotic for the treatment of acute epididymitis 4.
- For patients with chlamydial infection, treatment with erythromycin or tetracycline is recommended 5.
- Local infiltration of the spermatic cord with 1% Scandicain solution may also improve fertility outcomes in patients with acute epididymitis 6.
Antibiotic Treatment
The choice of antibiotic treatment depends on the suspected causative organism.
- Neisseria gonorrhoeae and Chlamydia trachomatis are commonly treated with ceftriaxone and doxycycline 3, 7.
- Enteric organisms are typically treated with levofloxacin or ofloxacin 3.
- Chlamydial infection is usually treated with erythromycin or tetracycline 5.
Importance of Treatment
Untreated acute epididymitis can lead to infertility and chronic scrotal pain, making recognition and therapy vital to reduce patient morbidity 3.