From the Guidelines
Treatment for epididymitis should involve antibiotics, pain management, and supportive measures, with a focus on microbiologic cure, improvement of signs and symptoms, prevention of transmission, and decrease in potential complications, as recommended by the most recent guidelines 1. The treatment approach may vary depending on the suspected cause of epididymitis, with sexually transmitted infections requiring specific antibiotic regimens.
- For bacterial epididymitis, a 10-14 day course of antibiotics is recommended, with common regimens including doxycycline 100mg twice daily or levofloxacin 500mg once daily.
- If sexually transmitted infections are suspected, ceftriaxone 1000mg as a single intramuscular or intravenous injection plus a course of an antibiotic active against Chlamydia trachomatis may be used, as suggested by the European Association of Urology guidelines 1. Key aspects of treatment include:
- Pain management with NSAIDs like ibuprofen 400-600mg every 6-8 hours or naproxen 500mg twice daily.
- Supportive measures such as bed rest, scrotal elevation with a folded towel or athletic supporter, and application of cold packs to reduce swelling.
- Adequate hydration and avoiding sexual activity until symptoms resolve are also important.
- If an abscess develops or symptoms worsen despite treatment, surgical intervention may be necessary, as indicated by the guidelines 1. It is essential to note that the treatment approach should be guided by the most recent and highest-quality evidence, prioritizing morbidity, mortality, and quality of life as outcomes, as recommended by the European Association of Urology guidelines 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 (inflammation of the epididymis) is doxycycline 100 mg, by mouth, twice a day for at least 10 days for cases caused by N. gonorrhoeae or C. trachomatis 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.
- 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.
- Antibiotic therapy with tetracycline was effective for the treatment of men with Chlamydia trachomatis epididymitis, and should be offered to the female sex partners 4.
- For men with epididymitis caused by enteric organisms, fluoroquinolones such as ciprofloxacin have been the mainstay of treatment, but rising resistance to ciprofloxacin means that alternative antimicrobials may be necessary 5.
- Initial outpatient therapy is empirical and targets the most common pathogens, with ceftriaxone and doxycycline recommended for Chlamydia trachomatis and Neisseria gonorrhoeae, and ofloxacin or levofloxacin recommended for coliform bacteria 6.
- New therapies including short-term therapy with fluoroquinolones or azalides (e.g. azithromycin) are very effective and easy to use, but vigilance is needed for the emergence of resistant strains to these agents 7.