- 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.
For epididymitis most likely caused by gonococcal or chlamydial infection:
Ceftriaxone 250 mg IM in a single dose
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
Levofloxacin 500 mg orally once daily for 10 days
- 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.