Treatment of Epididymitis and Orchitis

Epididymitis consists of an acute or chronic inflammation affecting the epididymis. The infection may spread from the epididymis to the testicle, and it is called epididymo-orchitis. Acute epididymitis is one of the most frequent urological infectious conditions in men. The infection may spread from the epididymis to the testicle, and it is called epididymo-orchitis. The most common causes of epididymo-orchitis are due to sexually transmitted infections (STIs) including Neisseria gonorrhoeae and Chlamydia trachomatis, or the infection may be due to Enterobacteriaceae. The most important differential diagnosis to rule out is testicular torsion, more frequent in children and young men. The diagnostic workup should include a urine culture and urethral swab to isolate the microorganism involved. Polymerase chain reaction (PCR) studies for N. gonorrhoeae, Mycoplasma, and Chlamydia isolation may be required. A scrotal ultrasound is the primary imaging study and enables differential diagnosis of testicular torsion or a tumor. Empirical antimicrobial treatment of acute epididymo-orchitis consists of antibiotics effective against C. trachomatis and Enterobacteriaceae such as levofloxacin or ofloxacin. Doxycycline and tetracyclines constitute an alternative in the treatment of C. trachomatis. A single dose with parenteral third-generation cephalosporin is indicated if infection due to N. gonorrhoeae is suspected. Chronic epididymitis is defined as cases where complete resolution is not achieved or the clinical symptoms last at least 6 weeks. The management of chronic epididymo-orchitis is frequently a challenging task. Several treatments have been proposed, including nonsteroidal anti-inflammatory agents, antibiotics, phytotherapy, anxiolytics, spermatic cord blockage with anesthesia or microdenervation of the spermatic cord, and epididymectomy in refractory cases.