Epididymoorchitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]
Overview
Management of epididymoorchitis consists mainly of conservative measures, including bed rest and limitation of physical activity, use of cold packs, analgesia and non-steroidal anti-inflammatory drugs (NSAIDs). In addition, appropriate antibiotic therapy should be initiated if the cause of epididymoorchitis is bacterial.[1][2][3]
Medical Therapy
If acute epididymitis is most likely caused by chlamydia or gonorrhea
- Preferred regimen: Ceftriaxone 500mg IM single dose PLUS doxycycline 100mg PO bid for 10 days.[4]
If acute epididymitis most likely caused by chlamydia, gonorrhea, or enteric organisms (men who practice insertive anal sex)
- Preferred regimen: Ceftriaxone 500mg IM single dose PLUS levofloxacin 500mg PO qd for 10 days.[4]
If acute epididymitis most likely caused by enteric organisms only
- Occurs in patients who have been through prostate biopsy, vasectomy, and other urinary tract instrumentation procedures;
- Preferred regimen: Levofloxacin 500mg PO qd for 10 days.[4]
- If patient weights more than 150kg - give ceftriaxone 1gr IM single dose.
If etiology is likely viral
Antibiotics are not necessary if the underlying etiology is likely viral such as mumps orchitis or other viral epididymoorchitis. Management of epididymoorchitis consists mainly of conservative measures, including:[1][2][3]
- Bed rest and limitation of physical activity;
- Scrotal elevation;
- Use of cold packs
- Analgesia
- Non-steroidal anti-inflammatory drugs (NSAIDs)
Alarm signs
- Severe pain or fever suggests other diagnoses (e.g., torsion, testicular infarction, abscess, or necrotizing fasciitis);
- Patients that are unable to comply to antibiotic treatment;
- Age;
- History of diabetes;
- Elevated C-reactive protein.
These may indicate higher severity and indicate hospitalization.[4]
References
- ↑ 1.0 1.1 Trojian TH, Lishnak TS, Heiman D (2009). "Epididymitis and orchitis: an overview". Am Fam Physician. 79 (7): 583–7. PMID 19378875.
- ↑ 2.0 2.1 Stewart A, Ubee SS, Davies H (2011). "Epididymo-orchitis". BMJ. 342: d1543. PMID 21490048.
- ↑ 3.0 3.1 Tracy CR, Steers WD, Costabile R (2008). "Diagnosis and management of epididymitis". Urol. Clin. North Am. 35 (1): 101–8, vii. doi:10.1016/j.ucl.2007.09.013. PMID 18061028.
- ↑ 4.0 4.1 4.2 4.3 Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I; et al. (2021). "Sexually Transmitted Infections Treatment Guidelines, 2021". MMWR Recomm Rep. 70 (4): 1–187. doi:10.15585/mmwr.rr7004a1. PMC 8344968 Check
|pmc=value (help). PMID 34292926 Check|pmid=value (help).