Treatment

• Indicated for all patients with acute epididymitis

• Start empiric antibiotic treatment based on the most likely causative organism. [2]

  • Patients with a suspected UTI source (e.g., enteric organisms): fluoroquinolone, e.g., levofloxacin [4]

  • Patients with a suspected STI source (e.g., chlamydia or gonorrhea): ceftriaxone PLUS doxycycline

• Adjust antibiotic therapy once the causative organism is identified.

• If symptoms do not improve within 72 hours after starting treatment, reconsider other diagnoses.

Symptomatic management

Indicated for all patients as needed

• Scrotal elevation

• NSAIDs

• Avoidance of aggravating activities

• Application of a cold pack

Surgical intervention

• Not generally indicated

• Exceptions include intrascrotal abscesses and some cases of chronic epididymitis

• Epididymal abscess

• Epididymo-orchitis: the spread of infection from the epididymis to the testicle

• Testicular infarction

• Infertility