Epididymo-orchitis Organism-Specific Therapy

Updated: Oct 17, 2019
  • Author: Edmund S Sabanegh, Jr, MD; Chief Editor: Thomas E Herchline, MD  more...
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Specific Organisms and Therapeutic Regimens

Organism-specific therapeutic regimens for epididymo-orchitis are provided below, including those for Escherichia coli, Klebsiella species, and other enteric organisms; Chlamydia trachomatis; and Neisseria gonorrhoeae. [1, 2, 3, 4] Special considerations [1, 2, 1, 5, 6] are also provided.

E coli, Klebsiella species, other enteric organisms

Antimicrobial regimens for these organisms include the following:

C trachomatis

Antimicrobial regimens for Chlamydia include the following [4] :

Alternative regimens for Chlamydia include the following [4] :

N gonorrhoeae

Antimicrobial regimens for gonorrheal infections include the following [3] :

  • Ceftriaxone 250 mg IM in a single dose plus
  • Azithromycin 1 g PO in a single dose
  • If ceftriaxone is not available, cefixime, 400 mg orally in a single dose, can be substituted in combination therapy
  • Fluoroquinolones are not recommended to treat gonococcal infections unless susceptibility testing is performed

Special considerations

See the list below:

  • Midstream urine cultures and Gram stains are useful to guide therapy
  • Urinalysis findings are positive for pyuria in only 25% of patients, and urine may be sterile in 40-90% of patients
  • Obtain a urethral swab culture (before void, after prostate massage) for gonorrheal and chlamydial infections if the patient is sexually active
  • Use imaging studies, particularly Doppler ultrasonography, to help distinguish acute epididymitis from the more ominous testicular torsion
  • Use ultrasonography to help detect a scrotal abscess as well as complications of epididymitis and bacterial or pyogenic orchitis [7]
  • Urine coliforms are grown in culture to determine speciation
  • Persistent symptoms or inadequate treatment can result in chronic epididymitis or abscess

Adjunctive therapy

If there is concern for sexually transmitted diseases such as infections with C trachomatis or N gonorrhoeae:

  • The patient’s sexual partners should be evaluated and treated
  • The patient should abstain from sexual relations until 7d after single-dose therapy or until completion of a 7-d regimen

Supportive therapy:

  • Reduce physical activity; provide scrotal support and elevation; use ice packs, anti-inflammatory agents, and analgesics, including nerve blocks; avoid urethral instrumentation; use sitz baths