Patient handout

Acute epididymitis ± orchitis (STI / enteric / viral / TB / drug / torsion-pivot DDx)

PRODUCTION

1. Your condition

This handout is for acute epididymitis ± orchitis (sti / enteric / viral / tb / drug / torsion-pivot ddx). Your care team identified this based on: gradual unilateral scrotal pain + swelling over hours to days (eau urological infections 2017).

Other reasons your team may use this plan: posterior testicular tenderness localised to epididymis (prehn sign — relief with elevation suggestive, not diagnostic) (eau 2017); dysuria / urethral discharge + scrotal pain in young man — sti-acquired (cdc sti 2021); recent urologic instrumentation or insertive anal intercourse — enteric pathogen (eau 2017).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
ceftriaxone	500 mg IM × 1	IM	single dose	CDC STI 2021 — increased dose to 500 mg IM (was 250 mg) for gonorrhea coverage; single dose; pair with doxycycline (PMID 33417591)
doxycycline	100 mg PO BID × 10 days	PO	BID × 10 days	CDC STI 2021 — chlamydia + M. genitalium coverage; 10-day course for epididymitis (longer than urethritis 7-day)
metronidazole	500 mg PO BID × 10 days	PO	BID × 10 days	Add for insertive anal sex (enteric + anaerobe overlap) or trichomonas (CDC STI 2021)

Plan: Acute epididymitis ± orchitis — STI dual therapy (CDC 2021) + enteric FQ/TMP-SMX (EAU 2017) + mumps supportive + TB/brucella ID-directed + abscess drainage + supportive

3. When to call your provider

Contact your care team if any of the following happen:

Treatment failure at 48–72 h → admit + POCUS for abscess / consider torsion pivot (EAU 2017; AUA 2017)
Fever ≥38.5°C → admit (abscess / sepsis; EAU 2017)
Sepsis screen positive → ED (SCC 2026)
Discrete fluctuant mass → STAT urology (abscess; EAU 2017)
Suspected torsion (sudden onset, TWIST 5–7, absent flow) → STAT OR (AUA 2017)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Sudden severe pain + N/V + absent cremasteric + high-riding testis OR TWIST 5–7 OR absent intratesticular flow on POCUS — STAT OR for testicular torsion (route off engine to uro.testicular-torsion.v1) (Barbosa 2013; AUA 2017; Friedman 2017)(life-threatening)
Discrete fluctuant scrotal mass OR POCUS confirms discrete fluid collection OR failure of 48–72 h empiric — epididymo-orchitic abscess (EAU 2017)

5. Follow-up

Urology if non-resolving > 2 wk / suspected malignancy / abscess; fertility counsel if bilateral / mumps; chronic epididymalgia management; STI re-test in 3 months (CDC STI 2021; EAU 2017)

6. Sources

Guideline: CDC STI Treatment Guidelines 2021 (Workowski MMWR) + acute scrotal pain reviews (Emerg Med Clin North Am; Ann Med Surg systematic review) + epididymo-orchitis ultrasound/UA utility study + adult testicular-torsion review (torsion pivot)