From the Guidelines
Epididymo-orchitis treatment guidelines are focused on antimicrobial stewardship and empiric therapy.
Key Recommendations
- The primary goal of treatment is to achieve a microbiologic cure of infection, improve signs and symptoms, prevent transmission to others, and decrease potential complications such as infertility or chronic pain 1.
- Empiric therapy is indicated before culture results are available, and treatment should be guided by the most likely causative pathogens, which are Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in men <35 years of age 1.
- NAATs are the most sensitive and rapid diagnostic procedure for CT and GC, and each commercially available system has its own collection kit 1.
- Antimicrobial stewardship is crucial to combat the rising threat of antimicrobial resistance, and recommendations for antibiotic selection, dosing, and duration should be based on the latest evidence 1.
Treatment Approach
- Bed rest, scrotal elevation, and analgesics are recommended as adjunctive therapy until fever and local inflammation have subsided 1.
- Fungal and mycobacterial disease are uncommon, and laboratory diagnosis requires communication from the clinician to the laboratory to ensure proper medium selection and processing 1.
- Viral orchitis is most frequently ascribed to mumps virus, and diagnosis is made by IgM serology for mumps antibodies, or by acute and convalescent IgG serology 1.
From the Research
Urology Guidelines for Epididymo-Orchitis Treatment
The treatment of epididymo-orchitis involves a combination of antibiotics, analgesics, and in some cases, surgery. The following are some key points to consider:
- The European Association of Urology guidelines recommend immediate treatment with antibiotics and analgesics after diagnosis, with surgery considered if there is no clinical improvement within 48-72 hours 2.
- A study published in the Central European Journal of Urology proposed a classification system for acute epididymo-orchitis, dividing it into three stages and recommending an approach to treatment based on the stage of the disease 3.
- Treatment approaches may vary depending on the severity of the disease, with mild and moderate cases often treated conservatively with antibiotics and analgesics, while severe cases may require surgery 4, 3.
- The choice of antibiotic may depend on the suspected cause of the infection, with ciprofloxacin and doxycycline commonly used for sexually transmitted infections, and alternative antimicrobials considered for enteric organisms 5, 6.
Key Considerations
- A sexual history should be documented in all cases of epididymo-orchitis, and mid-stream urine samples and urethral swabs should be sent for culture and testing for sexually transmitted infections 2.
- Patients with epididymo-orchitis should be followed up to ensure resolution of symptoms and to detect any potential complications 2, 5.
- The management of epididymo-orchitis in primary care may vary, with a study finding that many patients received antibiotics without specific testing for sexually transmitted infections 5.