• Empiric therapy is indicated before culture results are available
• Treatment of epididymitis caused by C. trachomatis or N. gonorrhoeae will result in
  • Microbiologic cure of infection
  • Improvement of signs and symptoms
  • Prevention of transmission to others
  • A decrease in potential complications (e.g., infertility or chronic pain)
  • As an adjunct to therapy, bed rest, scrotal elevation, and analgesics are recommended until fever and local inflammation have subsided.

Recommended Regimens

For epididymitis most likely caused by gonococcal or chlamydial infection:
Ceftriaxone 250 mg IM in a single dose
     PLUS
Doxycycline 100 mg orally twice a day for 10 days

For epididymitis most likely caused by enteric organisms, for patients allergic to cephalosporins and/or tetracyclines, or for epididymitis in patients aged >35 years:
Ofloxacin 300 mg orally twice a day for 10 days
     OR
Levofloxacin 500 mg orally once daily for 10 days

Follow-Up

• Failure to improve within 3 days of the initiation of treatment requires reevaluation of both the diagnosis and therapy
• Swelling and tenderness that persist after completion of antimicrobial therapy should be evaluated comprehensively The differential diagnosis includes tumor, abscess, infarction, testicular cancer, TB, and fungal epididymitis.

References

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