This protocol applies to sexually transmitted epididymo-orchitis where gonorrhoea is considered unlikely and M. genitalium has not been identified — and where the first-line antibiotic course failed to achieve the expected response.
Epididymo-orchitis with a suspected sexually transmitted cause. None of the recognised gonorrhoea risk factors are present: no purulent urethral discharge, no known contact with a gonorrhoeal infection, not a man who has sex with men, and black ethnicity absent. M. genitalium has not been identified. Gonorrhoea is therefore considered unlikely in this setting.
The initial regimen — Ceftriaxone (intramuscular injection) combined with Doxycycline (oral, twice daily for 10–14 days) — was the standard first-line approach for sexually transmitted epididymo-orchitis. The expected clinical goals were improvement in scrotal pain and swelling within 3 days and full resolution of symptoms by 2 weeks. These endpoints were not achieved, indicating the need for an alternative approach.
Sexually transmitted epididymo-orchitis.
Where gonorrhoea is considered unlikely, urethral/FPU microscopy negative for Gram-negative intracellular diplococci, no risk factors for gonorrhoea identified (absence of all of the following – a purulent urethral discharge, known contact of a gonorrhoeal infection, men who have sex with men, black ethnicity) and in countries/populations where there is known very low gonorrhoea prevalence, omitting ceftriaxone or using ofloxacin could be considered.
Ofloxacin 200 mg twice daily for 14 days IIB; OR Levofloxacin 500 mg once daily for 10 days IIIB
At three days if there is no improvement in symptoms, the patient should be seen for clinical review and the diagnosis should be reassessed.
At two weeks to assess for treatment compliance, assessment of symptoms and partner notification.
DOI: 10.1177/0956462417699356
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