From the Guidelines
Epididymitis treatment should involve antibiotics active against Chlamydia trachomatis and Enterobacterales, with a recommended regimen of ceftriaxone 1000 mg intramuscularly or intravenously plus a course of an antibiotic active against Chlamydia trachomatis, as outlined in the 2024 European Association of Urology guidelines 1.
Treatment Approach
The treatment approach for epididymitis involves a combination of antibiotics and supportive care.
- Antibiotics: The choice of antibiotics depends on the suspected cause of the infection. For sexually transmitted infections, a combination of ceftriaxone and an antibiotic active against Chlamydia trachomatis is recommended 1.
- Supportive care: Rest, scrotal elevation, and anti-inflammatory medications like ibuprofen 400-600mg three times daily can help manage pain and swelling.
Diagnosis and Treatment Algorithm
The diagnosis and treatment algorithm for epididymitis involves a clinical assessment, laboratory tests, and imaging studies.
- Clinical assessment: A thorough clinical assessment is essential to determine the severity of the infection and the need for urgent surgical exploration.
- Laboratory tests: Midstream urine for culture, urethral swab/smear, and first voided urine for nucleic acid amplification test (NAAT) can help identify the underlying cause of the infection.
- Imaging studies: Scrotal ultrasound examination can help diagnose complications such as abscesses or testicular torsion.
Follow-up and Complications
Follow-up is essential to monitor the response to treatment and to identify potential complications.
- If symptoms do not improve within 3 days of antibiotic therapy, patients should seek further medical evaluation as this may indicate complications or an incorrect diagnosis.
- Chronic epididymitis may require longer antibiotic courses or additional interventions if standard treatment fails. The 2024 European Association of Urology guidelines provide a comprehensive approach to the diagnosis and treatment of epididymitis, emphasizing the importance of prompt and effective treatment to prevent complications and improve outcomes 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 epididymus) is doxycycline 100 mg, by mouth, twice a day for at least 10 days for cases caused by N. gonorrhoeae or C. trachomatis 2.
From the Research
Treatment for Epididymitis
The treatment for epididymitis, which is the inflammation of the epididymis, depends on the cause of the infection.
- For sexually transmitted infections (STIs) caused by Chlamydia trachomatis or Neisseria gonorrhoeae, the recommended treatment is:
- For coliform bacteria, the recommended treatment is ofloxacin or levofloxacin 3
- The treatment for chlamydial infection is a seven-day course of doxycycline, 100 mg taken by mouth twice per day 5
- Azithromycin, a new antibiotic of the azalide class, has also been shown to be effective in the treatment of uncomplicated genital infections caused by C. trachomatis, with single-dose oral therapy being as effective as a standard 7-day twice-daily course of doxycycline 6
Diagnosis and Testing
Diagnosis of epididymitis is typically made through a combination of physical examination, laboratory tests, and medical history.
- Laboratory studies, including urethral Gram stain, urinalysis and culture, and polymerase chain reaction assay for C. trachomatis and N. gonorrhoeae, help guide therapy 3
- Acceptable specimen types for testing include vaginal, endocervical, rectal, pharyngeal, and urethral swabs, and first-stream urine samples 5
Follow-up and Prevention
Follow-up testing is important to ensure that the infection has been fully treated and to prevent reinfection.