What is the treatment for a patient with hand foot mouth disease and epididymitis (inflammation of the epididymis)?

Treatment for Hand-Foot-Mouth Disease with Epididymitis

For patients with hand-foot-mouth disease and concurrent epididymitis, treatment should include antibiotics for the epididymitis (ceftriaxone 250 mg IM single dose plus doxycycline 100 mg orally twice daily for 10 days) along with supportive care for hand-foot-mouth disease (hydration, pain relief with acetaminophen or ibuprofen). 1, 2

Epididymitis Treatment

Antibiotic Therapy

Based on the likely causative organisms, empiric therapy should be initiated before culture results are available:

• For sexually transmitted epididymitis (most common in men <35 years):

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

• For epididymitis likely caused by enteric organisms (men >35 years, recent urinary tract instrumentation, or anatomical abnormalities):

  • Ofloxacin 300 mg orally twice a day for 10 days OR
  • Levofloxacin 500 mg orally once daily for 10 days 1

Supportive Measures for Epididymitis

• Bed rest, scrotal elevation, and analgesics until fever and local inflammation subside 1
• Failure to improve within 3 days requires reevaluation of diagnosis and therapy 1
• Consider hospitalization if severe pain suggests other diagnoses (torsion, testicular infarction, abscess) or if patient is febrile 1

Diagnostic Evaluation for Epididymitis

• Gram-stained smear of urethral exudate for diagnosis of urethritis 1
• Culture or nucleic acid amplification test for N. gonorrhoeae and C. trachomatis 1
• Examination of first-void urine for leukocytes if urethral Gram stain is negative 1
• Syphilis serology and HIV counseling and testing 1

Hand-Foot-Mouth Disease Management

Supportive Care

• Treatment is primarily supportive as the disease is self-limiting and typically resolves in 7-10 days 2, 4
• Focus on hydration and pain relief with acetaminophen or ibuprofen as needed 2
• Oral lidocaine is not recommended, and no specific antiviral treatment is available 2

Clinical Presentation and Course

• Characterized by low-grade fever, maculopapular or papulovesicular rash on hands and feet, and painful oral ulcerations 2
• Primarily affects children under 10 years but can occur in adults with potentially more severe presentation 5
• Transmitted by fecal-oral, oral-oral, and respiratory droplet contact 2

Special Considerations

Potential Complications

• Hand-foot-mouth disease is usually benign but can rarely lead to neurologic or cardiopulmonary complications 2
• Epididymitis can lead to complications such as infertility or chronic pain if not properly treated 1

HIV-Infected Patients

• Patients with uncomplicated epididymitis who are HIV-positive should receive the same treatment regimen as HIV-negative patients 1
• Be aware that fungi and mycobacteria are more likely to cause epididymitis in immunosuppressed patients 1

Prevention of Spread

• Hand-foot-mouth disease: Handwashing and disinfecting potentially contaminated surfaces 2
• Epididymitis: Patients with sexually transmitted epididymitis should refer sex partners for evaluation and treatment if contact occurred within 60 days preceding symptom onset 1
• Avoid sexual intercourse until therapy is completed and symptoms have resolved 1

Follow-Up

• For epididymitis: Swelling and tenderness that persist after completing antibiotics should be comprehensively evaluated for other conditions (tumor, abscess, infarction, testicular cancer, tuberculous or fungal epididymitis) 1
• For hand-foot-mouth disease: Monitor for resolution of symptoms within 7-10 days 4