From the Guidelines
Epididymitis should be treated with empiric antibiotics, such as doxycycline 100mg twice daily or ciprofloxacin 500mg twice daily, for 1-2 weeks, as it is usually caused by bacterial infection, either sexually transmitted or urinary tract infections, and this treatment will result in microbiologic cure, improvement of signs and symptoms, prevention of transmission to others, and a decrease in potential complications. The choice of antibiotic depends on the likely cause, with sexually transmitted infections, such as chlamydia or gonorrhea, being more common in younger men, and urinary tract infections being more common in older men 1.
Causes and Symptoms
- Epididymitis is an inflammation of the epididymis, a coiled tube at the back of the testicle that stores and carries sperm.
- It is usually caused by bacterial infection, either sexually transmitted (like chlamydia or gonorrhea) in younger men or urinary tract infections in older men.
- Symptoms include unilateral testicular pain and tenderness, hydrocele, and palpable swelling of the epididymis.
Treatment and Management
- Treatment typically involves antibiotics for 1-2 weeks, with doxycycline 100mg twice daily or ciprofloxacin 500mg twice daily being common choices, depending on the likely cause.
- For pain relief, take ibuprofen 400-600mg every 6-8 hours or acetaminophen 500-1000mg every 6 hours as needed.
- Rest, scrotal support (with tight underwear or an athletic supporter), and applying ice packs for 20-30 minutes several times daily can help reduce swelling and discomfort.
- It's essential to complete the full course of antibiotics even if symptoms improve.
- If symptoms worsen, include fever above 101°F, or don't improve after 3 days of antibiotics, seek immediate medical attention as complications can include abscess formation or reduced fertility 1.
Diagnosis and Evaluation
- The evaluation of men for epididymitis should include procedures to rule out testicular torsion, a surgical emergency, especially in adolescents and men without evidence of inflammation or infection 1.
- Emergency testing for torsion may be indicated when the onset of pain is sudden, pain is severe, or the test results available during the initial examination do not support a diagnosis of urethritis or urinary-tract infection.
From the Research
Definition and Causes of Epididymitis
- Epididymitis is the inflammation of the epididymis, commonly seen in the outpatient setting 2, 3.
- The etiology of epididymitis is largely unknown, but reflux of urine into the ejaculatory ducts is considered a common cause in children under 14 years old 2.
- In sexually active males between 14 and 35 years old, Neisseria gonorrhoeae and Chlamydia trachomatis are the most common pathogens 2, 3.
- In men over 35 years old, epididymitis is usually caused by enteric bacteria transported by reflux of urine into the ejaculatory ducts secondary to bladder outlet obstruction 2.
Symptoms and Diagnosis
- Epididymitis presents as the gradual onset of posterior scrotal pain, which may be accompanied by urinary symptoms such as dysuria and urinary frequency 2.
- Physical findings include a swollen and tender epididymis with the testis in an anatomically normal position 2, 3.
- Laboratory studies, including urethral Gram stain, urinalysis and culture, and polymerase chain reaction assay for C. trachomatis and N. gonorrhoeae, help guide therapy 3.
Treatment and Management
- The treatment of epididymitis is based on the likely causative organisms and patient age 2, 3.
- For sexually active males between 14 and 35 years old, a single intramuscular dose of ceftriaxone with 10 days of oral doxycycline is the treatment of choice 2.
- 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 2.
- In men over 35 years old, levofloxacin or ofloxacin alone is sufficient to treat these infections 2.
- Adherence to CDC guidelines for the treatment of acute epididymitis is often poor, with less than 35% of patients receiving the appropriate work-up and treatment 4.