From the Guidelines
The treatment of orchitis primarily focuses on relieving symptoms and addressing the underlying cause, with supportive measures including bed rest, scrotal elevation, and analgesics, as recommended by the 1998 guidelines for treatment of sexually transmitted diseases 1. The goal of treatment is to reduce morbidity, mortality, and improve quality of life by alleviating symptoms and preventing complications. For bacterial orchitis, antibiotics are the mainstay of treatment, typically fluoroquinolones like ciprofloxacin or ceftriaxone followed by doxycycline if sexually transmitted infections are suspected. For viral orchitis, which is often mumps-related, treatment is supportive and includes:
- Bed rest
- Scrotal elevation with a folded towel
- Ice packs applied for 15-20 minutes several times daily
- Pain management with NSAIDs like ibuprofen or acetaminophen In severe cases, narcotic analgesics may be necessary. Anti-inflammatory medications help reduce swelling and discomfort. Supportive measures include wearing athletic supporters or briefs rather than boxers to provide scrotal support. Patients should avoid strenuous activities until symptoms improve, typically within 1-2 weeks. If an abscess develops, surgical drainage may be required, as noted in the 2002 sexually transmitted diseases treatment guidelines 1. Prompt treatment is essential to prevent complications like testicular atrophy, infertility, or chronic pain, and patients should complete the full course of antibiotics even if symptoms improve earlier to ensure complete eradication of the infection, as hospitalization may be considered in severe cases 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 orchitis with doxycycline is 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 should be continued for at least 10 days.
From the Research
Treatment of Orchitis
The treatment of orchitis typically involves addressing the underlying cause of the infection.
- For sexually transmitted infections (STIs) such as Chlamydia trachomatis and Neisseria gonorrhoeae, which are common causes of orchitis in younger men, antibiotics like ceftriaxone and doxycycline are recommended 3, 4.
- In cases where coliform bacteria are suspected, ofloxacin or levofloxacin may be prescribed 4.
- A single dose of azithromycin has also been shown to be effective in treating non-gonococcal urethritis and chlamydial cervicitis, with clinical cure rates comparable to a one-week course of doxycycline 5.
Considerations for Treatment
It is essential to differentiate orchitis from testicular torsion, a surgical emergency that requires immediate attention 3, 4.
- Patients with severe pain or systemic symptoms should be referred for further evaluation and treatment, which may include analgesia, IV antibiotics, and hydration 3.
- The choice of antibiotic regimen may depend on various factors, including the suspected pathogen and the patient's age and medical history.
Potential Complications
Orchitis can lead to complications such as testicular atrophy and reduced fertility, particularly if left untreated or if treatment is delayed 6.
- Chronic asymptomatic inflammations of the testicles can also contribute to male fertility disorders, highlighting the need for prompt and effective treatment 6.