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)
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