Epididymoorchitis medical therapy

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Epididymoorchitis Microchapters


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Historical Perspective




Differentiating Epididymoorchitis from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis


History and Symptoms

Physical Examination

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Medical Therapy


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: José Eduardo Riceto Loyola Junior, M.D.[2]; Dima Nimri, M.D. [3]


Management of epididymoorchitis consists mainly of conservative measures, including bed rest and limitation of physical activity, use of cold packs, analgesia and non-steroidal anti-inflammatory drugs (NSAIDs). In addition, appropriate antibiotic therapy should be initiated if the cause of epididymoorchitis is bacterial. All men with acute epididymitis should be tested for HIV and syphilis.

Medical Therapy

If acute epididymitis is most likely caused by chlamydia or gonorrhea

If acute epididymitis most likely caused by chlamydia, gonorrhea, or enteric organisms (men who practice insertive anal sex)

If acute epididymitis most likely caused by enteric organisms only

  • Occurs in patients who have been through prostate biopsy, vasectomy, and other urinary tract instrumentation procedures;
  • Preferred regimen: Levofloxacin 500mg PO qd for 10 days.[1]
    • If patient weights more than 150kg - give ceftriaxone 1gr IM single dose.

If etiology is likely viral

Antibiotics are not necessary if the underlying etiology is likely viral such as mumps orchitis or other viral epididymoorchitis. Management of epididymoorchitis consists mainly of conservative measures, including:[2][3][4]

Alarm signs

  • Severe pain or fever suggests other diagnoses (e.g., torsion, testicular infarction, abscess, or necrotizing fasciitis);
  • Patients that are unable to comply to antibiotic treatment;
  • Age;
  • History of diabetes;
  • Elevated C-reactive protein.

These may indicate higher severity and indicate hospitalization.[1]

Management of partners

  • Patients should be told to refer all sex partners during the previous 60 days before symptom onset for evaluation, testing, and presumptive treatment.
  • If the last sexual intercourse was >60 days before onset of symptoms or diagnosis: most recent sex partner should be evaluated and treated.
  • Abstain from sexual intercourse until symptoms have resolved (partners included).

HIV infection


  1. 1.0 1.1 1.2 1.3 Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I; et al. (2021). "Sexually Transmitted Infections Treatment Guidelines, 2021". MMWR Recomm Rep. 70 (4): 1–187. doi:10.15585/mmwr.rr7004a1. PMC 8344968 Check |pmc= value (help). PMID 34292926 Check |pmid= value (help).
  2. Trojian TH, Lishnak TS, Heiman D (2009). "Epididymitis and orchitis: an overview". Am Fam Physician. 79 (7): 583–7. PMID 19378875.
  3. Stewart A, Ubee SS, Davies H (2011). "Epididymo-orchitis". BMJ. 342: d1543. PMID 21490048.
  4. Tracy CR, Steers WD, Costabile R (2008). "Diagnosis and management of epididymitis". Urol. Clin. North Am. 35 (1): 101–8, vii. doi:10.1016/j.ucl.2007.09.013. PMID 18061028.