Epididymo-orchitis
The regional formulary will not cover all eventualities for infections medicines choices. As with any condition; patient specific factors and sensitivities need to be considered. Please consider this regional formulary advice alongside any relevant local Board guidelines.
Treatment of bacterial epididymo-orchitis (STI cause suspected)
If STI suspected refer to GUM. Consider important safety issues and potentially long-lasting side-effects prior to prescribing (see prescribing notes).
Doxycycline
Doxycycline 100mg capsules
100mg every 12 hours for 14 days.
Prescribing Notes:
- Send an MSU in all patients and complete a urine NAAT to exclude chlamydia and/or gonorrhoea prior to initiating antibiotics.
- Torsion of the spermatic cord (testicular torsion) is the most important differential diagnosis. It is a surgical emergency. It should be considered in all patients and should be excluded first as testicular salvage IS REQUIRED WITHIN 6 HOURS and becomes decreasingly likely with time.
- With any genital symptoms consider a sexually transmitted infection (STI) test including chlamydia, gonorrhoea, HIV and syphilis.
History Notes
30/07/2026
Regional formulary chapter launched.
Treatment of bacterial epididymo-orchitis (UTI cause suspected)
Co-trimoxazole
Co-trimoxazole 80mg/400mg tablets
960mg twice a day for 10-14 days.
Ciprofloxacin
Ciprofloxacin 250mg tablets
500mg twice a day for 10-14 days.
Prescribing Notes:
- Refer to BNF important safety information for all quinolones prior to prescribing.
- See MHRA Drug Safety Update (January 2024): Fluoroquinolones must only be used in situations when other antibiotics, that are commonly recommended for the infection, are inappropriate such as:
- there is resistance to other first-line antibiotics recommended for the infection
- other first-line antibiotics are contraindicated in an individual patient
- other first-line antibiotics have caused side effects in the patient requiring treatment to be stopped
- treatment with other first-line antibiotics has failed
- Send an MSU in all patients and consider a urine NAAT to exclude chlamydia and/or gonorrhoea.
- Torsion of the spermatic cord (testicular torsion) is the most important differential diagnosis. It is a surgical emergency. It should be considered in all patients and should be excluded first as testicular salvage IS REQUIRED WITHIN 6 HOURS and becomes decreasingly likely with time.
- With any genital symptoms consider a sexually transmitted infection (STI) test including chlamydia, gonorrhoea, HIV and syphilis.
- Co-trimoxazole 80mg/400mg tablets are more cost-effective dose for dose than 160mg/800mg tablets.
- Ciprofloxacin 250mg tablets are more cost-effective dose for dose than 500mg tablets.
History Notes
30/07/2026
Regional formulary chapter launched.