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Chlamydial Epididymitis — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesChlamydial EpididymitisRACP Adult Medicine

A 35-year-old man presents with a 2-day history of acute scrotal pain and swelling. He has dysuria and urethral discharge. Examination shows a tender, swollen left epididymis with an elevated cremasteric reflex. Urinalysis shows pyuria. Urine and urethral PCR are positive for Chlamydia trachomatis. What is the appropriate antibiotic treatment?

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Correct answer: D — Azithromycin 1 g single dose

In sexually active men <35 years, acute epididymitis is most commonly caused by sexually transmitted organisms (Chlamydia trachomatis, Neisseria gonorrhoeae). Treatment should cover both: ceftriaxone 500 mg IM single dose (gonorrhoea) PLUS doxycycline 100 mg BD for 14 days (chlamydia). Since this patient has confirmed Chlamydia only, doxycycline alone for 14 days is acceptable. However, eTG recommends empirical coverage for both STIs pending full results. In men >35, enteric organisms (E. coli) are more common and are treated with fluoroquinolones. Sexual partner notification and treatment are essential.

Reference: eTG – 2025 – Antibiotic Guidelines; ASHM – 2024 – STI Guidelines