Treatment of Epididymitis

Epididymitis is a sexually transmitted infection in men. Most of the sexually transmitted epididymitis are acute and generally affect only on one side. Epididymitis causes pain, tenderness (pain on pressure to that part), swelling of epididymis and these symptoms may or may not be accompanied by signs and symptoms of urethritis (infection/inflammation of urethra).

What are the causative organisms of acute sexually transmitted epididymitis?

Most commonly the causative organisms of acute sexually transmitted epididymitis is Clamydia trachomatis and less commonly due to N. gonorrhea, especially in case of males below 35 years of age and sexually active.

Other conditions which should be differentiated from acute epididymitis are torsion of testis, trauma or due to tumor. In torsion of testis, which is a surgical emergency there is sudden onset of pain, the testicle is located in the scrotal sac, there is rotation of the epididymis from a posterior to an anterior position. In torsion of testis on Doppler study there is absence of blood flow to the testis. If symptoms do not subside after complete treatment with appropriate antibiotics, it suggests tumor or a granulomatous disease like tuberculosis. In trauma there is history of trauma.

Treatment of epididymitis:

The treatment of choice for acute epididymitis is ceftriaxone 250 mgs single dose intramuscularly followed by doxycycline 100 mg orally two times a day for next 10 days. This regime cures acute epididymitis due to Clamydia trachomatis as well as due to N. gonorrhea. Previously fluoroquinolones like ciprofloxacin were used, but at present not recommended due to emergence of resistance against fluoroquinolones.  Levofloxacin is used sometimes if the causative organism of epididymitis is found to be Enterobacteriaceae, but it is not useful if epididymitis is due to other organisms.

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