Organism-specific therapeutic regimens for epididymo-orchitis are provided below, including those for Escherichia coli, Klebsiella species, and other enteric organisms; Chlamydia trachomatis; and Neisseria gonorrhoeae. [1, 2, 3, 4] Special considerations [1, 2, 1] are also provided.
E coli, Klebsiella species, other enteric organisms
Antimicrobial regimens for these organisms include the following:
C trachomatis
Antimicrobial regimens for Chlamydia include the following [4] :
Alternative regimens for Chlamydia include the following [4] :
N gonorrhoeae
Antimicrobial regimens for gonorrheal infections include the following :
Special considerations
See the list below:
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Midstream urine cultures and Gram stains are useful to guide therapy
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Urinalysis findings are positive for pyuria in only 25% of patients, and urine may be sterile in 40-90% of patients
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Obtain a urethral swab culture (before void, after prostate massage) for gonorrheal and chlamydial infections if the patient is sexually active
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Use imaging studies, particularly Doppler ultrasonography, to help distinguish acute epididymitis from the more ominous testicular torsion
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Use ultrasonography to help detect a scrotal abscess as well as complications of epididymitis and bacterial or pyogenic orchitis
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Urine coliforms are grown in culture to determine speciation
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Persistent symptoms or inadequate treatment can result in chronic epididymitis or abscess
Adjunctive therapy
If there is concern for sexually transmitted diseases such as infections with C trachomatis or N gonorrhoeae:
Supportive therapy:
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Reduce physical activity; provide scrotal support and elevation; use ice packs, anti-inflammatory agents, and analgesics, including nerve blocks; avoid urethral instrumentation; use sitz baths