Overview
Tuberculous epididymo-orchitis is an inflammation of the epididymis and testis caused by Mycobacterium tuberculosis. It is a less common cause of epididymo-orchitis, particularly in developed countries, but should be considered in endemic areas or in individuals with risk factors for tuberculosis 1.Diagnosis
Objective swelling and tenderness on testicular examination should prompt empirical treatment 1.
Diagnostic tests include microscopy, culture, and nucleic acid amplification tests (NAATs) for Mycobacterium tuberculosis* 1.Management
Empirical treatment should be initiated in patients with objective swelling and tenderness on testicular examination 1.
First-line empirical treatment for sexually acquired epididymo-orchitis is ceftriaxone 1g intramuscularly and doxycycline 1.
Higher doses of ceftriaxone are recommended to ensure effective treatment of strains with reduced susceptibility 1.
Ofloxacin or doxycycline is recommended for patients with epididymo-orchitis likely due to non-gonococcal organisms (e.g., negative Gram stain for intracellular diplococci or no risk factors for gonorrhea) 1.Key Recommendations
Empirical treatment should be started in patients with objective swelling and tenderness on testicular examination 1. (Evidence: Expert opinion)
First-line empirical treatment for sexually acquired epididymo-orchitis has changed to ceftriaxone 1g intramuscularly and doxycycline 1. (Evidence: Expert opinion)
Higher dose of ceftriaxone in line with the BASHH 2018 gonorrhoea guideline ensures effective treatment of strains with reduced susceptibility 1. (Evidence: Expert opinion)References
1 Chirwa M, Davies O, Castelino S, Mpenge M, Nyatsanza F, Sethi G et al.. United Kingdom British association for sexual health and HIV national guideline for the management of epididymo-orchitis, 2020. International journal of STD & AIDS 2021. link