Epididymo-Orchitis
NHSL Antimicrobial Guidelines
Choose regimen based on immediate tests –urinalysis and taking into account age, sexual history, recent surgery/catheterisation, any known urinary tract abnormalities and the local prevalence of gonorrhoea and antibiotic resistance patterns. Send first pass urine for chlamydia and gonorrhoea NAAT; and MSSU. Refer to GUM for IM ceftriaxone if gonorrhoea suspected.
If patient systemically unwell, or concern regarding testicular torsion, please refer urgently to urology for same day review
Drug details
Drug
For epididymo-orchitis most probably due to any sexually transmitted pathogen(for example: <35 years old; a new sexual partner or more than one sexual partner in past year; lack of consistent condom use and a contact of a sexually transmitted infection):
Refer to GUM for testing and treatment
Ceftriaxone
Dosage
1g IM
Duration
single dose
Drug
PLUS
Doxycycline
Dosage
100mg
Duration
orally twice daily 14 days
Drug
For epididymo-orchitis most probably due to chlamydia or other non-gonococcal organisms (for example, where gonorrhoea has been ruled out by gram stain and no risk factors for gonorrhoea identified*):
Consider referral to GUM if confirmed or suspected STI (for partner notification)
Doxycycline
Dosage
100mg
Duration
orally twice daily 14 days
Drug
OR
Ofloxacin
*Common risk factors for gonorrhoea are: previous N. gonorrhoeae infection; known contact of gonorrhoea; presence of purulent urethral discharge, men who have sex with men and multiple recent sexual partners.
Dosage
200mg
Duration
orally twice daily 14 days (consider safety issues with quinolones)
Drug
If epididymo-orchitis most likely due to enteric organisms (for example: >35 years old; no new sexual risk; known urinary tract abnormalities; recent surgery/catheterisation)
Ofloxacin
Dosage
200mg
Duration
twice daily 14 days
Drug
OR
Levofloxacin
Dosage
500mg
Duration
once daily 10 days
(Consider safety issues with quinolones)