Antibiotic Treatment for Epididymitis

Etiology and Treatment Selection

The Centers for Disease Control and Prevention recommends ceftriaxone 250 mg IM single dose plus doxycycline 100 mg orally twice a day for 10 days as the regimen of choice for men under 35 years old, while ofloxacin or levofloxacin are preferred for men over 35 years old 1, 2
For men under 35 years old, the recommended regimen is ceftriaxone 250 mg IM single dose plus doxycycline 100 mg orally twice a day for 10 days, which covers the most common pathogens in this age group 1, 2, 3
For men over 35 years old, the recommended regimen is ofloxacin 300 mg orally twice a day for 10 days or levofloxacin 500 mg orally once a day for 10 days, which is more effective against enteric organisms 1, 2

Bed rest, scrotal elevation, and analgesics are recommended until fever and local inflammation have decreased, with reevaluation if no improvement is seen within 3 days of starting treatment 1, 2, 3

Sexual partners of patients with epididymitis caused by N. gonorrhoeae or C. trachomatis should be evaluated and treated, with referral if contact with the index patient was within 60 days prior to symptom onset 1, 2

Patients with HIV and uncomplicated epididymitis should receive the same treatment regimen as HIV-negative patients, while immunosuppressed patients are more prone to fungal and mycobacterial infections 1, 2
Hospitalization should be considered when severe pain suggests other diagnoses or when patients have fever or may not comply with the antimicrobial regimen 2, 3

The differential diagnosis includes tumor, abscess, infarction, testicular cancer, tuberculosis, and fungal epididymitis, with torsion of the testicle being a surgical emergency that should be considered in all cases 1, 2
Torsion of the testicle is more frequent in adolescents and is a surgical emergency that requires prompt attention 2, 3