Acute Epididymitis Management

Diagnostic Evaluation and Treatment

The Centers for Disease Control and Prevention recommends obtaining specific diagnostic tests to guide treatment and identify sexually transmitted infections that require partner notification, including Gram-stained smear of urethral exudate or intraurethral swab, nucleic acid amplification test (NAAT) or culture of intraurethral swab or first-void urine for N. gonorrhoeae and C. trachomatis, and first-void uncentrifuged urine examination for leukocytes if urethral Gram stain is negative, with culture and Gram stain of this specimen 1
The Centers for Disease Control and Prevention recommends syphilis serology and HIV testing with appropriate counseling 1
For sexually active men ages 14-35 years, the standard regimen is ceftriaxone 250 mg IM single dose PLUS doxycycline 100 mg orally twice daily for 10 days, as recommended by the Centers for Disease Control and Prevention 1
For men who practice insertive anal intercourse, the Centers for Disease Control and Prevention recommends using ceftriaxone 250 mg IM single dose PLUS levofloxacin 500 mg orally once daily for 10 days OR ofloxacin 300 mg orally twice daily for 10 days 1
For men over 35 years or enteric organism infection, the Centers for Disease Control and Prevention recommends treating with levofloxacin 500 mg orally once daily for 10 days OR ofloxacin 300 mg orally twice daily for 10 days as monotherapy 1, 2

The Centers for Disease Control and Prevention recommends that all patients require bed rest, scrotal elevation, and analgesics until fever and local inflammation subside 1, 3, 2
Patients must reevaluate all patients within 72 hours of initiating treatment, as recommended by the Centers for Disease Control and Prevention 1, 3, 2

The Centers for Disease Control and Prevention instructs patients with confirmed or suspected N. gonorrhoeae or C. trachomatis infection to refer all sex partners from the preceding 60 days for evaluation and treatment 1
Patients must avoid all sexual intercourse until both they and their partners complete therapy and are asymptomatic, as recommended by the Centers for Disease Control and Prevention 1, 3
For HIV-infected patients, the Centers for Disease Control and Prevention recommends treating using the same regimens as HIV-negative patients 1, 3
For pediatric patients under 14 years, treatment should focus on enteric organisms with fluoroquinolones, as recommended by the Centers for Disease Control and Prevention 3

The minimum treatment duration for all epididymitis cases is 10 days, as recommended by the Centers for Disease Control and Prevention 1, 3, 2