Warning

Choose regimen based on immediate tests –urinalysis and taking into account age, sexual history, recent surgery/catheterisation, any known urinary tract abnormalities and the local prevalence of gonorrhoea and antibiotic resistance patterns. Send first pass urine for chlamydia and gonorrhoea NAAT; and MSSU. Refer to GUM for IM ceftriaxone if gonorrhoea suspected.

If patient systemically unwell, or concern regarding testicular torsion, please refer urgently to urology for same day review

Drug details

Drug

For epididymo-orchitis most probably due to any sexually transmitted pathogen(for example: <35 years old; a new sexual partner or more than one sexual partner in past year; lack of consistent condom use and a contact of a sexually transmitted infection):

Refer to GUM for testing and treatment

Ceftriaxone

Dosage

1g IM

Duration

single dose

Drug

PLUS             

Doxycycline

Dosage

100mg

Duration

orally twice daily 14 days

Drug

For epididymo-orchitis most probably due to chlamydia or other non-gonococcal organisms (for example, where gonorrhoea has been ruled out by gram stain and no risk factors for gonorrhoea identified*):

Consider referral to GUM if confirmed or suspected STI (for partner notification)

Doxycycline

Dosage

100mg

Duration

orally twice daily 14 days

Drug

OR

Ofloxacin

*Common risk factors for gonorrhoea are: previous N. gonorrhoeae infection; known contact of gonorrhoea; presence of purulent urethral discharge, men who have sex with men and multiple recent sexual partners.

Dosage

200mg

Duration

orally twice daily 14 days (consider safety issues with quinolones)

Drug

If epididymo-orchitis most likely due to enteric organisms (for example: >35 years old; no new sexual risk; known urinary tract abnormalities; recent surgery/catheterisation)

Ofloxacin

Dosage

200mg

Duration

twice daily 14 days

Drug

OR

Levofloxacin

Dosage

500mg

Duration

once daily 10 days

(Consider safety issues with quinolones)

Editorial Information

Last reviewed: 18/05/2022

Next review date: 18/05/2025

Author(s): NHS Lanarkshire Antimicrobial Management Committee, Dr Dundas, Dr Hylands, S McCormick, Heather Boyle.

Version: V1

Approved By: AMC; ADTC

Reviewer name(s): Heather Boyle, NHS Lanarkshire Antimicrobial Management Committee.

Document Id: June 2022