What is the recommended treatment for a 26-year-old male with epididymitis?

Treatment for Epididymitis in a 26-Year-Old Male

For a 26-year-old male with epididymitis, the recommended treatment is ceftriaxone 250 mg IM in a single dose PLUS doxycycline 100 mg orally twice a day for 10 days, targeting the most common causative organisms in this age group: Chlamydia trachomatis and Neisseria gonorrhoeae. 1

Antimicrobial Therapy Based on Age and Risk Factors

• In men under 35 years of age (including our 26-year-old patient), epididymitis is most commonly caused by sexually transmitted infections, particularly C. trachomatis and N. gonorrhoeae 1, 2
• The first-line treatment regimen consists of:
  • Ceftriaxone 250 mg IM as a single dose 3, 1
  • PLUS
  • Doxycycline 100 mg orally twice daily for 10 days 3, 4
• For patients allergic to cephalosporins and/or tetracyclines, an alternative regimen is:
  • Ofloxacin 300 mg orally twice a day for 10 days 3, 1
  • OR
  • Levofloxacin 500 mg orally once daily for 10 days 3, 1

Adjunctive Measures

• In addition to antimicrobial therapy, the following supportive measures are recommended:
  • Bed rest until fever and local inflammation subside 3, 1
  • Scrotal elevation to reduce pain and swelling 3, 1
  • Analgesics for pain management 3, 1

Follow-Up Recommendations

• Clinical improvement should be observed within 3 days of initiating treatment 3, 1
• If no improvement occurs within 3 days, reevaluation of both diagnosis and therapy is necessary 3, 1
• Persistent swelling or tenderness after completing the full course of antibiotics requires comprehensive evaluation for alternative diagnoses including:
  • Tumor
  • Abscess
  • Testicular infarction
  • Testicular cancer
  • Tuberculous or fungal epididymitis 3, 1

Management of Sex Partners

• Sexual partners of patients with epididymitis caused by STIs should be referred for evaluation and treatment if contact occurred within 60 days of symptom onset 3, 1
• The patient should avoid sexual intercourse until both he and his partner(s) have completed treatment and are symptom-free 3, 1

Important Clinical Considerations

• Testicular torsion must be ruled out in all cases of acute scrotal pain, as it is a surgical emergency requiring immediate intervention 1
• Testicular torsion is more common in adolescents and typically presents with sudden onset of severe pain 3, 1
• Epididymitis in men under 35 years presents with gradual onset of scrotal pain, often accompanied by urinary symptoms such as dysuria and frequency 2, 5
• Physical examination typically reveals a swollen, tender epididymis with the testis in normal anatomic position 2, 5

Special Considerations

• For patients who practice insertive anal intercourse, enteric organisms may also be causative, and treatment with ceftriaxone plus levofloxacin or ofloxacin may be more appropriate 2
• HIV-infected patients with uncomplicated epididymitis should receive the same treatment regimen as HIV-negative patients 3, 1
• Untreated epididymitis can lead to serious complications including infertility and chronic scrotal pain, making prompt and appropriate treatment essential 2