Epididymo-Orchitis

Antimicrobial prescribing: NHS Forth Valley
NHS Forth Valley

Micro Organisms

Most probably due to STI pathogen:

  • Age <35 years old
  • High risk sexual history (new sexual partner or multiple recent partners, lack of consistent condom use)
  • Contact of a STI
  • Urethral discharge present
  • Urine dipstick positive for leucocytes only

 

Most probably due to STI and Enteric pathogens:

  • STI risks (as above) in men who practice insertive anal sex

 

Most probably due to Enteric pathogens:

  • Age ≥ 35 years old
  • Low risk sexual history
  • Previous urological procedure
  • Men who engage in insertive anal intercourse
  • Men with known abnormalities of urinary tract
  • No urethral discharge
  • Positive urine dipstick for leucocytes and nitrites 

Most probably due to STI pathogen

Therapy

Ceftriaxone 1g IM + Doxycycline 100mg 12 hourly 10-14 days

Notes:

Epididymo-Orchitis most probably due to any STI pathogen:

  • Younger age (<35 years old)
  • High risk sexual history (new sexual partner or multiple recent partners, lack of consistent condom use)
  • Contact of a STI
  • Urethral discharge present
  • Urine dipstick positive for leucocytes only

Most probably due to STI and Enteric pathogens

Therapy

Ceftriaxone 1g IM stat dose

AND 

Ofloxacin 200mg 12 hourly (Alternative if quinolone not suitable: Co-amoxiclav 625mg 8 hourly) for 14 days

 

See also: MHRA Fluoroquinolone warning

Notes:

Most probably due to STI and Enteric pathogens:

  • STI risks in men who practice insertive anal sex

Most probably due to Enteric pathogens

Therapy

Ofloxacin 200mg 12 hourly for 14 days

(Alternatives if quinolone not suitable: Co-trimoxazole 960mg PO 12 hourly or Co-amoxiclav 625mg PO 8 hourly for 10 days)

 

See also: MHRA Fluoroquinolone warning

Notes:

Most probably due to Enteric pathogens:

  • Older age (≥ 35 years old)
  • Low risk sexual history
  • Previous urological procedure
  • Men who engage in insertive anal intercourse
  • Men with known abnormalities of urinary tract
  • No urethral discharge
  • Positive urine dipstick for leucocytes and nitrites 

Notes

Send First Void Urine for Chlamydia/Gonorrhoea NAAT (investigation for STI) and an MSU for routine C&S (investigation for enteric pathogens)

If poor clinical response consider imaging to exclude more complicated infection e.g. abscess formation and first void urine for mycoplasma genitalium

All patients with sexually transmitted epididymo-orchitis should be screened for other STI's including blood-borne viruses