Treatment

• bed rest
• scrotal elevation
• antibiotic treatment
  • empirical treatment is often with ciprofloxacin 500mg bd for 14 days
    • however treatment options must be chosen in consideration of regional antibiotic resistance patterns
  • the EAU have given therapy guidance for specific organisms (1,2):
    • Chlamydia trachomatis
      • first choice - quinolones with good activity against C. trachomatis (ofloxacin, levofloxacin)
      • second choice - doxycyline 2 × 100 mg for at least 14 days (macrolides are an alternative second choice treatment)
    • Enterobacteriaceae
      • first choice - quinolones
    • Neisseria gonorrhoeae - the EAU has no stated antibiotic regime
      • the German STD (Sexually Transmitted Diseases) Society has proposed the use of ciprofloxacin 500 mg as a single shot therapy, followed by doxycycline 2 × 100 mg/day for 2 weeks (1)
      • alternatively, ciprofloxacin 500 mg bd may be applied for the same time period as a monotherapy (1)
        
        
  • empirical antibiotic therapy has been suggested by Public Health England:
    • doxycycline 100mg BD for 10 to 14 days OR
    • ofloxacin 200mg BD for 14 days OR
    • ciprofloxacin 500mg BD for 10 days
      
      
• drainage if there is abscess formation
• possibly, pain relief with NSAID's e.g. mefenamic acid 500 mg tds
• non - exertion for 1-3 weeks

Key points (3):

• usually due to Gram-negative enteric bacteria in men over 35 years with low risk of STI
• if under 35 years or STI risk, refer to GUM

Notes:

• in case of C. trachomatis epididymitis, the sexual partner should also be treated (2)
• EAU guidance suggests supportive therapy including bed rest, up-positioning of the testes and antiphlogistic medication
  • antiphlogistic therapy with methylprednisolone, 40 mg per day, followed by a dose reduction by half every second day may be considered (1,2)

Reference:

• (1) Ludwig M. Diagnosis and therapy of acute prostatitis, epididymitis and orchitis.Andrologia. 2008 Apr;40(2):76-80.
• (2) Naber KG et al. EAU guidelines for the management of urinary and male genital tract infections. Eur Urol 2001;40:576-588 (updated 2006).
• (3) Public Health England (June 2021). Managing common infections: guidance for primary care