This protocol covers patients with epididymo-orchitis where a sexually transmitted aetiology is suspected — particularly younger men under 35 presenting with urethral discharge or urethritis — who have not shown adequate symptom improvement after three days on initial first-line treatment.
In men under 35, sexually transmitted pathogens ascending from the urethra are the predominant cause of epididymitis. This sub-population typically presents with features of urethral involvement — discharge or urethritis — alongside the epididymal and testicular inflammation.
The first-line approach for sexually transmitted epididymo-orchitis is Ceftriaxone plus Doxycycline, together with analgesia, rest, and scrotal support. This next-line protocol is indicated when symptom improvement has not occurred by day 3 of that initial regimen.
DOI: 10.1177/0956462417699356
It is usually caused by either sexually transmitted pathogens ascending from the urethra or non-sexually transmitted uropathogens spreading from the urinary tract.
Historically, STIs have been attributed as the predominant cause for epididymitis in the < 35 age group and enteric pathogens in the > 35 age group.
Ofloxacin 200 mg twice daily for 14 days IIB; OR
Levofloxacin 500 mg once daily for 10 days IIIB
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