Suspected STI origin:

Doxycycline oral 100mg 12 hourly

If risk factors for STI are present, refer to Sexual Health services, ideally for same day assessment: 

• younger patient
• high risk sexual history - a new sexual partner or more than one sexual partner in last 12 months
• contact of an STI
• no previous UTI
• urethral discharge present, urinalysis positive for leucocytes only

Send a mid-stream urine sample and test for sexually transmitted infections (NAAT). All patients with sexually transmitted epididymo-orchitis should be screened for other sexually transmitted infections. 

Not related to STI - enteric pathogens:

Ofloxacin oral 200mg 12 hourly

For more detailed information refer to the West of Scotland Sexual Health Managed Clinical Network guidelines.

• Consider mumps orchitis, tuberculosis, and amiodarone as possible causes; Behçet’s syndrome can present with recurrent epididymitis.
• Have a very low threshold for urgent urology referral of any male presenting with an acutely tender testicle to exclude testicular torsion. If the patient has diabetes or is immunocompromised and symptoms are severe, or the patient is very unwell, consider admitting to hospital.
• For non-STI infection, send a urine sample for culture. If a urinary tract infection is confirmed, refer to urology to investigate for underlying structural abnormality or urinary tract obstruction.
• Empirical therapy should be given to all patients with epididymo-orchitis before laboratory results are available.