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Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • bed rest
  • scrotal elevation
  • antibiotic treatment
    • empirical treatment is often with ciprofloxacin 500mg bd for 14 days
      • however treatment options must be chosen in consideration of regional antibiotic resistance patterns
    • the EAU have given therapy guidance for specific organisms (1,2):
      • Chlamydia trachomatis
        • first choice - quinolones with good activity against C. trachomatis (ofloxacin, levofloxacin)
        • second choice - doxycyline 2 × 100 mg for at least 14 days (macrolides are an alternative second choice treatment)
      • Enterobacteriaceae
        • first choice - quinolones
      • Neisseria gonorrhoeae - the EAU has no stated antibiotic regime
        • the German STD (Sexually Transmitted Diseases) Society has proposed the use of ciprofloxacin 500 mg as a single shot therapy, followed by doxycycline 2 × 100 mg/day for 2 weeks (1)
        • alternatively, ciprofloxacin 500 mg bd may be applied for the same time period as a monotherapy (1)

    • empirical antibiotic therapy has been suggested by Public Health England:
      • doxycycline 100mg BD for 10 to 14 days OR
      • ofloxacin 200mg BD for 14 days OR
      • ciprofloxacin 500mg BD for 10 days

  • drainage if there is abscess formation
  • possibly, pain relief with NSAID's e.g. mefenamic acid 500 mg tds
  • non - exertion for 1-3 weeks

Key points (3):

  • usually due to Gram-negative enteric bacteria in men over 35 years with low risk of STI
  • if under 35 years or STI risk, refer to GUM


  • in case of C. trachomatis epididymitis, the sexual partner should also be treated (2)
  • EAU guidance suggests supportive therapy including bed rest, up-positioning of the testes and antiphlogistic medication
    • antiphlogistic therapy with methylprednisolone, 40 mg per day, followed by a dose reduction by half every second day may be considered (1,2)


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