Epididymitis is usually treatable with antibiotics. Treatment should be started as soon as possible, even before the results of the tests are known, to decrease the risk of scarring to the epididymis and future infertility. If a sexually transmitted cause of epididymitis (such as gonorrhea or chlamydia) is suspected, the antibiotics generally used are a combination of ceftriaxone and doxycycline. However, if the infection is thought to have resulted from performing anal intercourse, then ofloxacin is the best antibiotic. If the cause is not thought to be a sexually transmitted bacterium, ofloxacin is again the best choice. If the swelling and pain are significant, bed rest and scrotal elevation are helpful in draining the infection from the testicle. Bed rest should be continued until the scrotum is no longer tender.
If the symptoms are not improved after about three days of treatment, a referral to a urologist is indicated. Rarely hospitalization is necessary to administer intravenous antibiotics. If swelling and tenderness persist after treatment, an evaluation may be performed for other possible causes of testicular pain and swelling, such as testicular cancer, tuberculosis, or fungal causes of epididymitis. These unusual infectious causes may be more common among men with compromised immune systems, such as men with human immunodeficiency virus (HIV) infection. Partners of men treated for epididymitis must also be evaluated and treated if the cause of infection is known or suspected to be from a sexually transmitted bacterium.
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