Overview
Infective epididymo-orchitis is an inflammatory condition affecting the epididymis and/or testicle, commonly caused by sexually transmitted infections such as Chlamydia trachomatis and Neisseria gonorrhoeae. 12Diagnosis
Clinical Presentation: Objective swelling and tenderness on testicular examination.
Diagnostic Imaging: Ultrasound is commonly used to confirm the diagnosis, performed in 94% of cases. 2
Microscopy: Examination for gram-negative intracellular diplococci (suggestive of Neisseria gonorrhoeae).
Microbiological Testing: Routine testing for Chlamydia trachomatis, especially in men under 35 years old, is recommended. 2Management
First-Line Treatment for Sexually Acquired Epididymo-Orchitis:
- Ceftriaxone 1g intramuscularly plus doxycycline.
- Higher dose of ceftriaxone to address reduced susceptibility strains of gonorrhea. 1
Alternative Treatment for Non-Gonococcal Causes:
- Ofloxacin or doxycycline for suspected non-gonococcal etiologies. 1
Chlamydia trachomatis Infection:
- Treatment with ofloxacin instead of ciprofloxacin, as ciprofloxacin is ineffective against Chlamydia. 2
Partner Management: Sexual partners should be tested and treated for Chlamydia trachomatis. 2Special Populations
Men Under 35 Years:
- Higher likelihood of Chlamydia trachomatis infection; should be treated with ofloxacin rather than ciprofloxacin. 2
No Specific Recommendations for Pregnancy, Pediatrics, or Elderly: Abstracts do not provide specific guidance for these populations.Key Recommendations
Initiate empirical treatment with ceftriaxone 1g intramuscularly and doxycycline for suspected sexually acquired epididymo-orchitis (Evidence: Strong 1).
Routinely test men under 35 years old for Chlamydia trachomatis and treat with ofloxacin (Evidence: Moderate 2).
Ensure sexual partners of patients with Chlamydia trachomatis are also tested and treated (Evidence: Expert opinion 2).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
2 Manavi K, Turner K, Scott GR, Stewart LH. Audit on the management of epididymo-orchitis by the Department of Urology in Edinburgh. International journal of STD & AIDS 2005. link