What is the recommended treatment for a 16-year-old male with orchitis?

Treatment of Orchitis in a 16-Year-Old Male

For a 16-year-old male with orchitis, the recommended treatment is doxycycline 100 mg orally twice daily for 7 days, as this targets the most common causative pathogens in this age group. 1, 2, 3

Etiology and Diagnosis

In adolescent males under 35 years of age, orchitis is most commonly caused by sexually transmitted infections:

• Chlamydia trachomatis (most common in this age group) 4
• Neisseria gonorrhoeae
• Less commonly, enteric bacteria (more common in men >35 years) 5

Before initiating treatment, the following diagnostic steps should be taken:

• Nucleic acid amplification tests (NAATs) for C. trachomatis and N. gonorrhoeae
• Urinalysis and urine culture
• Consider testing for mumps if clinically indicated (IgM serology) 1

Treatment Algorithm

First-line Treatment (Age <35 years)

• Doxycycline 100 mg orally twice daily for 7 days 1, 2, 3
• PLUS Ceftriaxone 125 mg intramuscularly as a single dose if gonorrhea cannot be excluded 1

Alternative Regimens (if doxycycline contraindicated)

• Azithromycin 1 g orally in a single dose 2
• Levofloxacin 500 mg orally once daily for 7 days 1, 2
• Ofloxacin 300 mg orally twice daily for 7 days 1, 2

Supportive Measures

• Bed rest
• Scrotal elevation
• Analgesics/anti-inflammatory medications
• Ice packs to reduce swelling

Special Considerations

• If no clinical improvement occurs within 48-72 hours of antibiotic therapy, consider urological referral to evaluate for potential complications or need for surgical intervention 6
• For cases with hydrocele or suspected abscess formation, ultrasound evaluation is recommended 6
• If mumps orchitis is suspected (especially during outbreaks), supportive care is the mainstay of treatment as antibiotics are not effective against viral causes 1

Follow-up Care

• Patients should abstain from sexual activity for 7 days after treatment initiation and until all partners are treated 2
• Advise the patient to return for evaluation if symptoms persist or worsen after completing therapy 1
• Consider repeat testing 3-6 months after treatment due to high risk of reinfection 2
• All sexual partners from the past 60 days should be notified, evaluated, and treated appropriately 2

Common Pitfalls to Avoid

1. Failure to distinguish from testicular torsion: Orchitis typically has a gradual onset of pain compared to the sudden onset in torsion. Immediate urological consultation is necessary if torsion cannot be excluded.

2. Inadequate testing: Only 50% of men diagnosed with epididymo-orchitis are tested for STIs, leading to inappropriate treatment 4. Always test for chlamydia and gonorrhea in adolescents.

3. Monotherapy for potential mixed infections: In adolescents, coverage for both chlamydia and gonorrhea is often necessary until test results are available 1.

4. Poor partner notification: Failure to treat partners leads to high reinfection rates 2.

By following this treatment approach, most cases of orchitis in adolescents will resolve without complications. The focus on doxycycline as first-line therapy addresses the most common pathogens in this age group while minimizing the risk of treatment failure and subsequent complications.