Clinical characteristics, management, and treatment outcomes of epididymo-orchitis among patients in a referral hospital in Southern Saudi Arabia

Epididymo-orchitis (EO) is a common genitourinary clinical syndrome in men, and delayed investigation and improper management can lead to complications. This study aimed to analyze clinical and laboratory findings and treatment outcomes in EO patients. We conducted a retrospective record-based study at King Abdullah Hospital in southern Saudi Arabia from 2018 to 2022, reviewing data from 63 EO patients who had a median age of 34 years (range: 16-82 years). The results showed that the most common complaints were scrotal pain and swelling (54%), followed by testicular pain (44.4%). Scrotal ultrasonography showed increased vascularity in both testes and epididymis in 49 patients (77.8%), while 14 patients (22.2%) had epididymal involvement alone. Reactive hydrocele was observed in 15 patients (23.8%), abscesses in seven (11.1%), and hypoechoic lesions in three (3.8%). Anti-Brucella antibody titers (>= 1:80) were detected in 22 cases, and 14.3% had positive urine cultures. Of the patients, 87.3% responded well to the initial treatment course, while four (6.3%) were cured after a second course of treatment. EO complications occurred in three cases (4.8%), and one patient (1.6%) succumbed to septicemia. Of the 15 patients treated with ceftriaxone and ciprofloxacin, one required orchiectomy due to non-response. Relapse occurred in one of the 10 patients treated with triple therapy (doxycycline, rifampicin and gentamicin). Among the nine patients treated with ceftriaxone and co-trimoxazole, one did not respond, developed a testicular abscess, and underwent incision and drainage. In conclusion, our study highlights that most cases of EO can be effectively resolved with appropriate antibiotic therapy, particularly combinations containing cefuroxime and/or ciprofloxacin. Clinicians in Brucella-endemic regions should consider the possibility of brucellosis as an underlying cause of EO.