What is the treatment for orchitis?

Treatment of Orchitis

The treatment of orchitis depends on its etiology, with bacterial orchitis requiring antibiotic therapy directed at the most likely causative organisms, while viral orchitis is managed with supportive care including analgesics, scrotal elevation, and rest.

Diagnosis and Classification

Before initiating treatment, it's essential to determine the cause of orchitis:

• Bacterial orchitis: Usually secondary to epididymitis (epididymo-orchitis)

  • In men <35 years: Commonly caused by sexually transmitted infections (STIs) like Chlamydia trachomatis and Neisseria gonorrhoeae 1
  • In men >35 years: More commonly caused by enteric organisms similar to those causing urinary tract infections 1, 2

• Viral orchitis: Primary infection of the testis

  • Most commonly caused by mumps virus
  • Other viral causes include Coxsackie virus, rubella virus, Epstein-Barr virus, and varicella zoster virus 1

Treatment Approach for Bacterial Orchitis/Epididymo-orchitis

For men <35 years (likely STI-related):

• First-line therapy:
  • Ceftriaxone 250 mg IM in a single dose PLUS
  • Doxycycline 100 mg orally twice a day for 10 days 1, 3

For men >35 years (likely enteric organisms) or those allergic to cephalosporins/tetracyclines:

• First-line therapy:
  • Ofloxacin 300 mg orally twice a day for 10 days OR
  • Levofloxacin 500 mg orally once daily for 10 days 1

Supportive measures (for all types of orchitis):

• Bed rest until fever and local inflammation subside
• Scrotal elevation
• Analgesics for pain control 1

Treatment Approach for Viral Orchitis

• No specific antiviral therapy is typically indicated
• Supportive care:
  • Analgesics for pain control
  • Scrotal elevation
  • Rest
  • Anti-inflammatory medications

Follow-Up and Monitoring

• Patients should show improvement within 3 days of starting treatment
• Failure to improve requires reevaluation of both diagnosis and therapy
• Persistent swelling and tenderness after completing antimicrobial therapy warrants comprehensive evaluation for other conditions including tumor, abscess, infarction, testicular cancer, tuberculosis, and fungal epididymitis 1

Management of Sexual Partners

For bacterial orchitis secondary to STIs:

• Sexual partners within the 60 days preceding symptom onset should be referred for evaluation and treatment
• Patients should avoid sexual intercourse until they and their partners complete therapy and are symptom-free 1

Special Considerations

Surgical Management

• Most cases of orchitis can be managed medically
• Surgical intervention may be necessary in cases with:
  • No clinical improvement after 48-72 hours of conservative treatment
  • Development of abscess
  • Testicular infarction 4

Testicular Torsion

• Must be ruled out in all cases of acute scrotal pain
• Surgical emergency requiring immediate consultation with a specialist
• More common in adolescents and presents with sudden onset of severe pain 1

Fournier's Gangrene

• Rare but serious complication requiring aggressive surgical debridement and broad-spectrum antibiotics 1

Diagnostic Evaluation

For accurate diagnosis and treatment planning:

• Gram-stained smear of urethral exudate
• Culture or nucleic acid amplification test for N. gonorrhoeae and C. trachomatis
• Examination of first-void urine for leukocytes
• Syphilis serology and HIV testing 1
• Ultrasound with Doppler to evaluate testicular blood flow and rule out torsion 1

By following this treatment algorithm based on patient age and likely etiology, most cases of orchitis can be effectively managed with good outcomes.