epididymo-orchitis

introduction

epididymo-orchitis is inflammation of the testes and usually falls into one of 4 main causes:
- urinary tract infections (UTIs) / cystitis associated (usually in pre-pubertal boys, the elderly or following urethral instrumentation)
- sexually transmitted infections (STDs/STIs) associated (usually younger men)
- mumps orchitis
- rare causes such as tuberculosis (TB), syphilis, brucellosis, meliodosis

in adolescents and younger men, one must first exclude possible torsion of the testes - consider urgent surgical consult within 1 hour in at risk patients, in very low risk patients an ultra-sound examination may be indicated.
send MSU m/c/s in all patients
consider sending urethral swab or 1st pass urine for Chlamydia and Gonococcal PCR in sexually active men

NB. the following are derived from ATG 2012 ¹⁾ but do not cover Pseudomonas aeruginosa or enterococci.

trimethoprim 300 mg (child: 6 mg/kg up to 300 mg) orally, daily for 14 days, or,
cephalexin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 12-hourly for 14 days, or,
amoxycillin+clavulanate 500+125 mg (child: 12.5+3.1 mg/kg up to 500+125 mg) orally, 12-hourly for 14 days, or,
if resistance is suspected in adults, norfloxacin 400 mg orally, 12-hourly for 14 days.

gentamicin 4 to 6 mg/kg (see Table 2.24) (child less than 10 years: 7.5 mg/kg; 10 years or more: 6 mg/kg) IV, for 1 dose, then determine dosing interval for a maximum of either 1 or 2 further doses based on renal function
PLUS
amoxycillin or ampicillin 2 g (child: 50 mg/kg up to 2 g) IV, 6-hourly.
in patients with HS to penicillins, gentamicin alone may be adequate, but if gentamicin contraindicated then:
- ceftriaxone 1 g (child: 25 mg/kg up to 1 g) IV, daily

ceftriaxone 500 mg in 2 mL of 1% lignocaine IM, or 500 mg IV, daily for 3 days (for gonorrhoea)
PLUS
- azithromycin 1 g orally, as a single dose
PLUS EITHER:
- doxycycline 100 mg orally, 12-hourly for 14 days, or,
- azithromycin 1 g orally, as a single dose 1 week later

NB. if HS to cephalosporins or immediate HS to penicillins, seek expert advice - see as for pelvic inflammatory disease (PID)

¹⁾