Testicular torsion, a surgical emergency, should be considered in the differential diagnosis of epididymo-orchitis.
Acute epididymo-orchitis:
- Doxycycline 100 mg bd (or 200 mg once-daily) for 10 - 14 days
If gonococcal infection cannot be immediatly ruled out, the following should be administered in addition to doxycycline;
- Ceftriaxone 500mg IM or IVI as single dose or for 3-5 days until clinical improvement
Bed rest, scrotal elevation, and analgesics are recommended until fever and local inflammation have subsided.
REVIEW
Signs and symptoms of acute epididymo-orchitis that do not subside within 3 days requires re-evaluation of the diagnosis and therapy
A repeat test to exclude re-infection is recommended at three months as re-infection rates are high. Test-of-cure is not recommended, exept in pregnancy. However, repeat testing should be performed at least 3 weeks after completion of treatment if symptoms persist or if there is concern regarding adherence or reinfection from an inadequately treated partner.
PARTNER NOTIFICATION
Partner notification should be discussed with patients. Consider referring patients to the Let Them Know website (www.letthemknow.org.au) which is designed to support patients to undertake partner notification and which facilitates sending of SMS and email messages to partners. Partners should be contacted, tested and treated without waiting for their test results. Individuals should abstain from sex with their partners until 7 days after both have received treatment.