Should I wait or seek medical attention for testicular swelling after completing azithromycin treatment for chlamydia and lymphogranuloma venereum?

Testicular Swelling After Chlamydia Treatment: When to Seek Medical Care

You should seek immediate medical attention for your testicular swelling as it may indicate epididymo-orchitis, a complication of chlamydia that requires prompt evaluation and potentially additional treatment. 1

Understanding Your Current Situation

• You were diagnosed with chlamydia and lymphogranuloma venereum (LGV) and completed a three-week course of weekly azithromycin (1g) 2
• Most symptoms have improved (pimples reducing, penile burning resolved) but new testicular swelling has appeared 1
• Testicular swelling, even without significant pain, is concerning for:
  • Possible epididymo-orchitis (inflammation of epididymis and testicle) as a complication of chlamydia 1
  • Potential treatment failure or reinfection 1
  • Possible concurrent infection with another pathogen 1

Why Immediate Medical Attention is Necessary

• Testicular swelling is not a normal part of the healing process and represents a new symptom that warrants evaluation 1
• While azithromycin is effective for chlamydia and LGV, the development of testicular swelling suggests:
  • Possible inadequate treatment of the infection 1, 2
  • Potential complications that may require additional or different antibiotics 1
  • Risk of fertility issues if epididymo-orchitis is not properly treated 1

What to Expect at Medical Evaluation

• Physical examination to assess the extent of testicular swelling 1
• Possible ultrasound to evaluate for epididymo-orchitis or other causes of swelling 1
• Potential urine or urethral testing to check for persistent infection 1
• Assessment for other sexually transmitted infections that might be contributing 1

Treatment Considerations

• If epididymo-orchitis is diagnosed, treatment typically includes:

  • Different or extended antibiotic therapy (often doxycycline 100mg twice daily) 1
  • Anti-inflammatory medications 1
  • Scrotal support and rest 1

• For persistent LGV specifically:

  • Doxycycline 100mg twice daily for 21 days is the standard treatment 3, 2
  • While azithromycin has shown efficacy in some studies, your new symptoms suggest the need for evaluation 2, 4

Follow-Up Recommendations

• After appropriate treatment, follow-up testing is recommended:
  • Test-of-cure is not routinely recommended for uncomplicated chlamydia but may be warranted given your complications 5
  • Retesting is recommended approximately 3 months after treatment completion to detect possible reinfection 5
  • All sexual partners from the past 60 days should be evaluated and treated to prevent reinfection 1, 5

Important Precautions

• Abstain from sexual activity until:

  • You complete any additional treatment prescribed 1
  • All symptoms, including testicular swelling, have completely resolved 1
  • All sexual partners have been treated 1, 5

• Be vigilant for worsening symptoms such as:

  • Increased pain or swelling 1
  • Fever 1
  • Difficulty urinating 1

Conclusion

The appearance of testicular swelling after treatment for chlamydia and LGV is concerning and requires prompt medical evaluation. While your other symptoms are improving, this new development suggests possible complications that need proper assessment and potentially additional treatment 1, 2.