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

Hi,

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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.

Hi,

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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.

Hello,

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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.