What is the recommended treatment for a patient diagnosed with Leptospirosis orchitis?

Leptospirosis Orchitis Treatment

Treat leptospirosis orchitis with doxycycline 100 mg orally twice daily for 7 days for mild-to-moderate disease, or ceftriaxone 2g IV daily for 7 days if the patient has severe systemic manifestations. 1

Understanding Leptospirosis Orchitis

Orchitis in leptospirosis is a manifestation of systemic infection during the septicemic phase, not a sexually transmitted infection requiring specialized orchitis-specific therapy. 1, 2 The treatment approach depends entirely on disease severity, not the presence of orchitis itself.

Treatment Algorithm Based on Disease Severity

Mild-to-Moderate Disease

Doxycycline 100 mg orally twice daily for 7 days is the treatment of choice. 1, 3

• This regimen reduces illness duration by approximately 2 days and favorably affects fever, malaise, headache, and myalgias. 3
• Alternative oral antibiotics include amoxicillin or tetracycline if doxycycline is unavailable. 1
• Azithromycin appears promising for less severe disease based on recent evidence. 4

Severe Disease (Weil's Disease)

Ceftriaxone 2g IV daily for 7 days is the preferred regimen. 1

• Penicillin G 1.5 million units IV every 6 hours for 7 days is an acceptable alternative. 1
• Start antibiotics immediately upon clinical suspicion without waiting for laboratory confirmation, as each hour of delay increases mortality. 1, 5
• Extend treatment to 10 days in patients with slow clinical response. 5

Criteria for Severe Disease

Admit to hospital and treat as severe disease if any of the following are present: 5, 2

• Jaundice with hemorrhagic manifestations
• Acute renal failure with proteinuria and hematuria
• Respiratory distress or pulmonary hemorrhage
• Persistent hypotension despite fluid resuscitation
• High bilirubin with mild transaminase elevation (distinguishes from viral hepatitis)

Critical Timing Considerations

Start treatment immediately upon clinical suspicion—do not wait for serological confirmation. 1, 5

• Serology is often negative in the first week, with IgM titers becoming positive only 6-10 days after symptom onset. 5, 2
• Blood cultures should be obtained before antibiotics if this causes no delay (<45 minutes), ideally within the first 5 days. 5, 2
• Treatment initiated after 4 days of symptoms may be less effective. 2

Supportive Care for Severe Disease

• Aggressive IV fluid resuscitation targeting systolic blood pressure >90 mmHg in adults, monitoring continuously for fluid overload. 5, 2
• ICU admission if persistent tissue hypoperfusion despite initial resuscitation or if respiratory distress develops. 5, 2
• Methylprednisolone 0.5-1.0 mg/kg IV daily for 1-2 weeks may be used for respiratory complications. 1

Special Populations

Children <8 Years

Avoid doxycycline due to risk of permanent tooth discoloration; use penicillin or ceftriaxone instead. 1

Pregnant Women

Avoid tetracyclines; use penicillin or ceftriaxone. 1, 2

Common Pitfalls to Avoid

• Do not discontinue antibiotics early despite clinical improvement—complete the full 7-10 day course. 1, 5
• Do not mistake leptospirosis for viral hepatitis in patients with fever and jaundice—leptospirosis typically shows high bilirubin with only mild transaminase elevation. 1, 2
• Do not delay treatment waiting for serological confirmation—serology is often negative in the first week when treatment is most critical. 1, 5
• Expect clinical improvement within 3 days of antibiotic initiation; if no improvement, reassess for complications or alternative diagnoses. 1, 2

Follow-Up

• Seriously ill patients should be followed up 2 days after the first visit to assess treatment response. 1
• Patients should return if symptoms persist longer than 3 weeks to evaluate need for extended treatment. 1
• Convalescent serology with microscopic agglutination test (MAT) should be repeated >10 days after symptom onset for diagnostic confirmation. 1, 2