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]

Medical Therapy

Management of epididymoorchitis consists mainly of conservative measures, including:

• Bed rest and limitation of physical activity
• Use of cold packs
• Analgesia
• Non-steroidal anti-inflammatory drugs (NSAIDs)
  

In addition, appropriate antibiotic therapy should be initiated if the cause of epididymoorchitis is bacterial. However, it is not necessary if the underlying etiology is mumps orchitis or other viral epididymoorchitis. The CDC recommends the following anti-bacterial regimens:

• If the cause is sexually transmitted (C. trachomatis or N. gonorrhea): Ceftriaxone 250 mg IM in single dose, plus Doxycycline 100 mg orally twice daily for 10 days
• If the cause is enteric bacteria: Levofloxacin 500 mg orally once daily for 10 days or Ofloxacin 300 mg orally twice a day for 10 days

Patients with epididymoorchitis are managed in an outpatient basis, unless one of the following signs or conditions are present:

1. Intractable pain, which can also suggest other serious diagnoses, such as testicular torsion, infarction or necrotizing fasciitis.
2. Failure of outpatient care.
3. Patient appears toxic, has severe systemic findings, such as fever and leukocytosis or signs of sepsis.
4. Suspicion of an abscess.
5. Severe vomiting and inability to tolerate oral medication.