Sexually transmitted epididymo-orchitis arises when pathogens ascend from the urethra to involve the epididymis and testis. Chlamydia trachomatis and Neisseria gonorrhoeae are the predominant causes, particularly in younger patients. Early, pathogen-directed antibiotic therapy is the cornerstone of management.
Epididymo-orchitis secondary to a sexually transmitted infection — caused by ascending Chlamydia trachomatis or Neisseria gonorrhoeae from the urethra, especially in younger sexually active patients.
Management centres on combination antibiotic therapy that provides coverage against both Chlamydia trachomatis and Neisseria gonorrhoeae. The regimen includes both an intramuscular and an oral antibiotic component, and where gonococcal infection is considered likely, additional antibiotic cover is incorporated.
Symptomatic improvement is expected by day three of treatment. For cases of gonococcal epididymo-orchitis, a test of cure using culture can be performed three days after completing treatment. Absence of improvement at day three warrants clinical review and reassessment of the diagnosis.
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.
Chlamydia trachomatis: especially in younger patients.
Neisseria gonorrhoeae: especially in younger patients.
Ceftriaxone 500 mg intramuscular injection IIIB PLUS Doxycycline 100 mg twice daily for 10–14 days IIIB.
In patients where gonorrhoea is considered likely (see risk factors above) azithromycin should be added to ceftriaxone and doxycycline to provide optimal antibiotic cover.
At three days if there is no improvement in symptoms, the patient should be seen for clinical review and the diagnosis should be reassessed.
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