From the Guidelines
Epididymitis should be treated with empiric therapy, including antibiotics, before culture results are available, to achieve microbiologic cure, improve signs and symptoms, prevent transmission, and decrease potential complications. The treatment of epididymitis typically involves antibiotics, with the goal of curing the infection, reducing symptoms, and preventing long-term complications such as infertility or chronic pain 1.
Key Considerations
- The most common causes of epididymitis are bacterial infections, including chlamydia and gonorrhea in younger men and E. coli or other urinary tract bacteria in older men.
- Treatment regimens may include doxycycline 100mg twice daily for 10 days or ceftriaxone 250mg as a single intramuscular injection plus doxycycline 100mg twice daily for 10 days, depending on the suspected cause.
- In addition to antibiotics, rest, scrotal elevation, and pain management with NSAIDs like ibuprofen 400-600mg every 6-8 hours are recommended.
- Applying ice packs to the scrotum for 20-30 minutes several times daily can help reduce swelling.
- It is essential to complete the full antibiotic course to prevent recurrence and to avoid sexual activity until symptoms resolve completely.
Potential Complications
- If symptoms worsen or do not improve within 3 days of treatment, immediate medical attention is necessary to rule out complications like abscess formation or testicular infarction.
- Testicular torsion, a surgical emergency, should be considered in all cases, especially in adolescents and men without evidence of inflammation or infection 1.
From the Research
Causes of Epididymitis
- Acute epididymitis is often caused by Chlamydia trachomatis and Neisseria gonorrhoeae in sexually active men under 35 years of age 2, 3, 4, 5
- In older men, children, or following urinary tract instrumentation, acute epididymitis is commonly caused by gram-negative bacilli 3
- Enteric organisms can also cause epididymitis in men who practice insertive anal intercourse 5
- Reflux of urine into the ejaculatory ducts is considered a common cause of epididymitis in children younger than 14 years 5
Diagnosis and Treatment
- A detailed sexual history and referral to a Genitourinary medicine clinic are important for diagnosis and treatment 2
- Quinolones, such as ciprofloxacin, are commonly prescribed as first-line antibiotics, but may not be the optimal choice for treating urogenital chlamydial infection 2
- Empirical antimicrobial therapy with fluoroquinolones or group 3 cephalosporins is often effective, but susceptibility testing is important to ensure appropriate treatment 6
- A single intramuscular dose of ceftriaxone with 10 days of oral doxycycline is the recommended treatment for sexually active males 14 to 35 years of age 5
- Levofloxacin or ofloxacin alone is often sufficient to treat epididymitis in men older than 35 years 5
Complications and Prevention
- Untreated acute epididymitis can lead to infertility and chronic scrotal pain, making recognition and therapy vital to reduce patient morbidity 5
- Supportive measures and antimicrobial agents are the mainstay of therapy, and Doppler ultrasonography and radionuclide scans may be used to differentiate epididymitis from other causes of acute scrotum 3