I chose a recently published systematic review article that discusses the treatment of acute epididymitis. As we’ve learned epididymitis is the inflammation of the epididymis associated with pain and swelling. There are different treatment options for men under 35 and men over 35 years of age due to the different etiologies associated with the age groups. Acute epididymitis in men 35 years and younger is typically due to sexually transmitted organisms such as Chlamydia trachomatis or Neisseria Gonorrhea; meanwhile epididymitis in men over 35 years of age is typically caused by non-sexually transmitted organisms such as E.Coli and Proteus. Therefore men under 35 typically get treated with ceftriaxone 250 to 500 mg IM in combination with doxycycline 100 mg orally twice a day for 10-14 days. Men with epididymitis that are over 35 are treated with ofloxacin 500 mg PO once daily for 10 days or ciprofloxacin 500 mg PO QD for 10 days. The CDC recommends ceftriaxone and levofloxacin or ofloxacin for acute epididymitis caused by sexually transmitted and enteric organisms. The article brings up some key points that warrant a revise in the current guidelines for the treatment options in epididymitis, The key points include a shift in the age distribution, causative organisms and the importance of sexual activity on the etiology for appropriate management. One causative pathogen of epididymis is M. Genitalium happens to be refractory to minocycline and cephalosporins, responds to levofloxacin albeit increasing resistance to the quinolone antibiotics.
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