Infectious Disease Compendium

Epididymitis

Diagnosis

Acute painful unilateral scrotum.

Granulomatous epididymitis is not uncommon after BCG (a treatment for bladder cancer) and can get worse with each treatment.

Do a urine culture for diagnosis and STD evaluation (C. trachomatis and for N. gonorrhoeae by NAAT).

Epidemiologic Risks

Sex, BCG.

Microbiology

Age > 35: coliforms (such as E. coli) or Pseudomonas.

Any age (usually < 35): C. trachomatis and N. gonorrhoeae (I always assume that people over age 35 (being > 50 I will neither confirm nor deny that bias) do not have sex, although the oldest clap I have seen was an 85 yo male. But that was in L.A. And what to do if your age is exactly 35 remains a mystery).

Chronic infectious epididymitis is most frequently Mycobacterium tuberculosis.

Empiric Therapy

For acute epididymitis most likely caused by sexually transmitted chlamydia and gonorrhea (2015 Guidelines)

Ceftriaxone 250 mg IM in a single dose .

PLUS

Doxycycline 100 mg orally twice a day for 10 days .

For acute epididymitis most likely caused by sexually-transmitted chlamydia and gonorrhea and enteric organisms (men who practice insertive anal sex).

Ceftriaxone 250 mg IM in a single dose.

PLUS

Levofloxacin 500 mg orally once a day for 10 days OR Ofloxacin 300 mg orally twice a day for 10 days.

For acute epididymitis most likely caused by enteric organisms Levofloxacin 500 mg orally once daily for 10 days OR Ofloxacin 300 mg orally twice a day for 10 days.

Last Update: 07/07/18.