Orchitis Guidelines

Updated: Jan 26, 2023
  • Author: Nataisia Terry, MD; Chief Editor: Erik D Schraga, MD  more...
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Guidelines Summary

The International Union against Sexually Transmitted Infections (IUSTI) has released guidelines on the management of epidiymo-orchitis that includes the following key recommendations [19] :

  • Information, explanation and advice should be given to the patient, including an explanation of the causes of epididymo-orchitis (both sexually transmitted and non-sexually transmitted), the short-term course of the infection, and the long-term implications for patients and partners, including partner notification if a sexually transmitted cause is identified or suspected.
  • Treatment includes analgesia, rest, and scrotal support.
  • Sexual abstinence recommended for those with a suspected sexually transmitted etiology until treatment is completed by both patient and partner and symptoms have resolved.
  • Empiric antibiotics should be given according to the likelihood of a sexually transmitted infection or uropathogen.

The recommended antibiotics for sexually transmitted epidiymo-orchitis include ceftriaxone (first line) and ofloxacin (second line).

The recommended antibioitic for epidiymo-orchitis secondary to enteric organisms is ofloxacin

When Mycoplasma genitalium testing has been performed and the organism identified, treatment should be guided to include an appropriate antibiotic (eg, moxifloxacin).

When Neisseria gonorrhoeae is considered unlikely, omitting ceftriaxone or using ofloxacin could be considered. Ofloxacin is not a first-line treatment for N gonorrhoeae because of increasing bacterial resistance to quinolones. In patients in whom N gonorrhoeae is considered likely, azithromycin should be added to ceftriaxone and doxycycline to provide optimal antibiotic coverage. [19]