Q. I have epididymo-orchitis and antibiotics did not help. Why?

Answered by
Dr. Samer S J Altawil
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Dec 09, 2020

Hello doctor,

I have an epididymo-orchitis infection. I went to the urologist, and he gave me antibiotics, taking it for two months, but the problem still is not going away. What to do in this situation?

I am currently on Ciprofloxacin 500 mg, Fosfomycine 3000 mg, and Azithromycin 500 mg.



Welcome to icliniq.com.

Epididymoorchitis is diagnosed mainly on ultrasound. It is a painful condition of the scrotum. It is mainly due to infections in the urinary tray secondary to STD (sexually transmitted disease) or obstruction to the lower urinary system like in the urethra or prostate. Differential diagnosis can be testicular torsion infected epididymal cyst or infected hydrocele.

Atypical infections causing epi-didymo orchitis are difficult to treat, and it will not respond to antibiotics. You took high-end oral antibiotics without effect.

Have you done an ultrasound? Where is the report? Do you have urinary symptoms like difficulty passing urine? Have you diagnosed with stricture of the urethra? How old are you? Did you have a urine culture done? Currently, what is your complaint pain or swelling?

Please follow up with answers to enable me to diagnose your issue better before we proceed.

Thank you doctor,

Yes, I took high-end oral antibiotics without effect. Ultrasound means echograph, then yes, I did that. In the attachment, you will find the conclusion of the urologist. No, I do not have urinary symptoms. I was not diagnosed with a stricture. Yes, the urologist did a urethra examination by hand. I am 32 years old. I did a urine culture in the hospital they say nothing strange. My complaint is infected epididymitis, swelling, cyst, and also infection of the testis.



Welcome back to icloniq.com.

After studying your case, I can find that you have chronic epididymitis secondary to STI. The best antibiotics to treat it are Doxycycline and Trimethoprim. In rare situations, if your treatment failed then you need to check urine for Tuberculosis as I have seen non-resolving epi-didymo orchitis caused by TB. Follow up ultrasound is important.

Please take tablet Doxycycline 100 mg twice daily for 14 days. Please repeat the ultrasound after treatment and show me the report.

Thank you doctor,

I am a little bit confused now I already took antibiotics for two months. Does this mean I am antibiotic-resistant? So do you still suggest taking Trimethoprim and Doxycycline? Should I tell my urologist to give me antibiotics again? Also, concerning the tuberculosis, I did a Mantoux test. The lady put an injection in my upper arm and injected some thing. A few days later, they say I do not have TB. I was not convinced, so can I ask them to test for TB?



Welcome back to icliniq.com.

Usually, we do a urine culture in the first place before we start the antibiotics. After taking antibiotics, cultures are usually negative therefore, I did not request for fresh urine culture. If still, epi-didymo orchitis is there, the treatment should be changed to another antibiotic. If you want, you can take a chance to do a urine culture before starting antibiotics.

For urine AFB, it should be done later if failed antibiotics treatment. Genitourinary TB is diagnosed on urine for AFB culture rather than the Mantoux test. Urine for AFB is more accurate for genitourinary TB.

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