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]

Medication

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Author

Nataisia Terry, MD Resident Physician, Department of Emergency Medicine, Kings County Hospital, State University of New York Downstate Medical Center

Nataisia Terry, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Society for Academic Emergency Medicine, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Coauthor(s)

Walter W Valesky, Jr, MD Clinical Assistant Instructor, Department of Emergency Medicine, Kings County Hospital, State University of New York Downstate Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Vice-Chair in Charge of Research, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Additional Contributors

Eric M Kardon, MD, FACEP Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center

Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Medical Association of Georgia

Disclosure: Nothing to disclose.

Acknowledgements

Mark B Mycyk, MD Associate Professor, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine

Mark B Mycyk, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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