Treatment of epididymo-orchitis

Epididymo-orchitis is usually easily treated with antibioticsPain usually takes about 3 days to resolve.  Swelling of the scrotum may be present for longer and will start to improve in about a week.  It must be remembered that sexual partners of men who have been diagnosed with epididymo-orchitis (when the cause is most likely to be from a sexually transmitted infection) should also be treated.

The management and treatment of epididymo-orchitis is briefly discussed:

  • Antibiotics

    The best antibiotic for a UTI related epididymo-orchitis is a Fluoroquinolone

    The type of antibiotic depends on what the probable underlying cause of the epididymo-orchitis is. The most likely cause often varies according to the patient’s age. An epididymo-orchitis from a sexually transmitted disease is more likely in patients under 35 years of age. Antibiotics should be started before the type of pathogen/bacteria is identified because treatment should not be delayed.
    The most common antibiotic regimes are mentioned:

    • Sexually transmitted disease suspected as most likely cause:
    • If a STD is suspected to be the cause of the patient’s epididymo-orchitis (which is more likely in younger patients) the following antibiotic regime is advised: Ceftriaxone given as an intra-muscular injection once with Azithromycin or Doxycycline as oral antibiotic treatment. The course of antibiotics should be completed as prescribed by the doctor, but usually for 7-14 days

    • Suspected Urinary tract infection as cause
    • If an UTI is suspected to be the cause of the patient’s epididymo-orchitis, the organism is most likely to be a gram-negative enteric organism. The best antibiotic for a UTI related epididymo-orchitis is a Fluoroquinolone. Fluoroquinolones penetrate well into the testes. An example of this type of regime would be taking an antibiotic called Ciprofloxacin orally twice a day for 10-14 days. It is important to complete antibiotics as advised.

  • Symptomatic treatment
    • Pain Medication
    • Pain medication, like the non-steroidal anti-inflammatory drugs, will provide pain relief and help reduce the inflammation of the testis. Additional analgesic medicine may also be used.

    • Supportive underwear
    • Wearing underwear with scrotal support will help relieve pain.

    • Ice-packs
    • Ice-packs (wrapped in cloth) will also provide relief from pain and will help reduce inflammation.

    • Sitz Baths
    • Sitz baths may help with pain relief. The perineal area should be submerged in warm or cold water.

  • Lifestyle adjustments

    Use condoms, don’t have more than 1 sexual partner, abstain from sex for 7 days, rest and don’t be too physically active

    • Using condoms
    • Sexually active patients should be encouraged to use condoms especially if they are not committed to one long-term sexual partner.

    • Not having more than 1 sexual partner at a time
    • Patients who developed epididymo-orchitis from a sexually transmitted disease should make sure they employ safe sexual practices and avoid sexual intercourse with multiple sexual partners. They should also bring their partner (or partners) to the doctor to be treated.

    • Abstaining from sex
    • A patient who has epididymo-orchitis should abstain from sex for 7 days from the date that treatment was started. It is very important for his partner to be treated or else he will get re-infected.

    • Reduce physical activity
    • When a patient is diagnosed with epididymo-orchitis he should rest and not be too physically active. Physical activity may worsen pain and delay the healing process.

Epididymitis and Orchitis, or epididymo-orchitis is a common condition among men.  This condition can be easily treated and does not usually cause many complications.  Men are encouraged to seek medical attention as soon as they develop the symptoms of epididymo-orchitis to prevent any damage to the epididymis and testis.

Complications of epididymo-orchitis


Complications which result from epididymo-orchitis are rare, patients usually fully recover when treated

Complications which result from epididymo-orchitis are rare. Patients usually fully recover when treated.  Possible complications which may occur are:

  • Abscess
  • An abscess may develop in the scrotum as a result of the infection. An abscess is a fluid-filled cavity containing pus. An abscess may cause a great deal of pain and will often have to be surgically drained.

  • Infertility or reduced fertility
  • Testicular tissue may be damaged from orchitis especially when the cause is the mumps virus or tuberculosis. After an episode of acute epididymo-orchitis which was properly treated reduced fertility is very rare. Epididymitis might result in blockage of the epididymal tube which will hinder sperm transport but both tubes are rarely affected.

  • Chronic inflammation
  • Chronic inflammation of the epididymis may occur with repeated bouts of infection. This chronic condition may be difficult to treat. Chronic inflammation of the testes is not well researched but some studies suggest that it may be a cause of chronic testicular pain called orchalgia.

  • Gangrene
  • Gangrene or tissue necrosis of the teticular tissues is very rare but might occur if epididymo-orchitis is not treated in a patient with an immune-compromised condition.

  • Decreased Testosterone production
  • Atrophy of the testis may occur during an episode of epididymo-orchitis caused by mumps or tuberculosis. Atrophy may lower the ability of that particular testis to produce testosterone.