From the Guidelines
Epididymitis treatment typically involves antibiotics, pain management, and supportive care, with a 10-14 day course of antibiotics recommended for acute bacterial epididymitis, as outlined in the most recent guidelines 1. The treatment approach for epididymitis is focused on eliminating the infection, reducing inflammation, and preventing complications.
- The most recent and highest quality study, published in 2024 1, provides a comprehensive guideline for the treatment of epididymitis, including the use of antibiotics such as ceftriaxone and doxycycline.
- Pain management is also crucial, with options including NSAIDs like ibuprofen 400-600mg every 6-8 hours or naproxen 500mg twice daily.
- Supportive care measures, such as bed rest, scrotal elevation, and ice packs, can help reduce swelling and discomfort.
- It is essential to note that if an abscess develops or symptoms worsen despite treatment, surgical intervention may be necessary.
- The treatment aims to improve morbidity, mortality, and quality of life by preventing complications like abscess formation or chronic pain, as highlighted in the study 1.
- The study also emphasizes the importance of referring sex partners for evaluation and treatment, as they may be asymptomatic carriers of the infection 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 epididymis) is doxycycline 100 mg, by mouth, twice a day for at least 10 days for cases caused by N. gonorrhoeae or C. trachomatis 2.
- The dosage is the same for both N. gonorrhoeae and C. trachomatis infections.
- The treatment duration is at least 10 days.
From the Research
Treatment of Epididymitis
The treatment of epididymitis depends on the patient's age and the likely causative organisms.
- For sexually active males between 14 and 35 years of age, the most common pathogens are Neisseria gonorrhoeae and Chlamydia trachomatis, and the treatment of choice is a single intramuscular dose of ceftriaxone with 10 days of oral doxycycline 3, 4, 5, 6.
- In men who practice insertive anal intercourse, an enteric organism is also likely, and ceftriaxone with 10 days of oral levofloxacin or ofloxacin is the recommended treatment regimen 3.
- In men older than 35 years, epididymitis is usually caused by enteric bacteria, and levofloxacin or ofloxacin alone is sufficient to treat these infections 3, 7.
- For patients younger than 35 years of age who have urethritis and suspected sexually transmitted disease, tetracyclines are the best agents and can be given intravenously at first if needed 4.
- For patients older than 35 years who have positive urine cultures for bacteria, urinary tract symptoms, a prior diagnosis of a urinary tract abnormality, or a history of a recent endourethral procedure, treatment can be given orally provided the symptoms are of moderate intensity, with either extra-strength cotrimoxazole or second-generation quinolones 4.
Antibiotic Therapy
Antibiotic therapy is effective for the treatment of epididymitis, and the choice of antibiotic depends on the suspected causative organism.
- Tetracycline is effective for the treatment of men with Chlamydia trachomatis epididymitis 5.
- Ceftriaxone is effective against Neisseria gonorrhoeae 3, 4, 6.
- Macrolides and second-generation quinolones are also effective against Chlamydia trachomatis 4.
- Fluoroquinolones, such as ciprofloxacin, have been used to treat epididymo-orchitis caused by enteric organisms, but rising resistance to ciprofloxacin means that alternative antimicrobials may be needed 7.