Treatment of Epididymo-Orchitis with Suspected Enteric Organism Infection
Clinical Scenario
This protocol applies to epididymo-orchitis cases where infection by an enteric organism is the suspected cause. The following risk factors identify this sub-population:
Obstructive urinary disease
Urinary tract surgery or instrumentation
Insertive anal intercourse
Microbiological Context
Epididymo-orchitis in this setting is most likely secondary to enteric organisms. Gram-negative enteric organisms are specifically implicated in men with obstructive urinary disease or a history of urinary tract surgery or instrumentation, and in men engaging in insertive anal intercourse.
Treatment Approach
Management centres on an antibiotic course directed at gram-negative enteric pathogens. The choice of agent and the treatment duration are set out in the full evidence-based protocol.
The complete regimen — including agent selection, dosing, and duration — is available in the structured protocol below.
Clinical Goals
- Improvement in scrotal pain and swelling at 3 days — if absent, clinical review and reassessment of diagnosis is required.
- Resolution of symptoms at 2 weeks — with assessment of treatment compliance and partner notification.
References
DOI: 10.1177/0956462417699356
- Epididymo-orchitis most likely secondary to enteric organisms
- Gram-negative enteric organism risk factors include obstructive urinary disease, urinary tract surgery or instrumentation
- Gram-negative enteric organisms: in men engaging in insertive anal intercourse.
- 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.
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