Regarding antibiotics, refer to local guidance regarding choice and duration, but a typical regime would be:

Low Risk of STI patient:

Ciprofloxacin 500mg BD PO for 10 days OR trimethoprim 200mg BD PO for 10 days 

High Risk of STI patient:

Ceftriaxone 500mg IM/IV single dose, then doxycycline 100mg BD PO for 10-14 days, ensuring GUM clinic follow-up

The British Association for Sexual Health and HIV has a national guideline for epididymo-orchitis.

Additionally, abstinence needs to be advised for the duration of treatment, as well as discussing contraception, where warranted. Complications can include recurrence (due to non-completion of antibiotic course, re-infection or chronic inflammation), hydrocele (usually resolves with antibiotics) abscess, infarction and infertility.

Remember that patients who are sexually active potentially have additional infections and should warrant screening via sexual health/GUM clinic. Patients may find scrotal support or elevation helpful, in addition to regular analgesics (over the counter NSAIDs, paracetamol +/- codeine should suffice)

Learning Bite

Antibiotics are needed for a longer outpatient duration than usual ED prescriptions, and patients need reminding of the importance of abstinence and completing courses even after clinical improvement or apparent resolution occurs.

All patients should be signposted toward local GUM/Sexual Health Services to ensure holistic care.