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Gonococcal Epididymo-Orchitis — RACP Adult Medicine MCQ

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EasyInfectious DiseasesGonococcal Epididymo-OrchitisRACP Adult Medicine

A 30-year-old man presents with severe scrotal swelling, purulent urethral discharge, and bilateral testicular pain. He is febrile with WCC 20 × 10⁹/L. Urine and urethral PCR are positive for both Neisseria gonorrhoeae and Chlamydia trachomatis. What is the recommended treatment?

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Correct answer: B — Ceftriaxone 500 mg IM STAT plus doxycycline 100 mg BD for 14 days

Explanation lettering: E = shown as A · C = shown as B · D = shown as C · B = shown as D · A = shown as E

For gonococcal and chlamydial epididymo-orchitis, dual therapy is required: ceftriaxone 500 mg IM as a single dose (for gonorrhoea – first-line in Australia given fluoroquinolone resistance) PLUS doxycycline 100 mg BD for 14 days (for chlamydia and to provide extended coverage for epididymal infection). Sexual partner notification and treatment, STI screening (HIV, syphilis, hepatitis B/C), and test of cure for gonorrhoea are essential components of management. Azithromycin as a single dose alone is insufficient for epididymitis.

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