Epididymitis ABX Suggestions?

[Will836]

I am a 22 y.o. male; 1 sexual partner lifetime, female, (for 2.5 years), we last had intercourse 6 mos. before the epididymitis flared up.

Problem started while I was taking minocycline for acne.  Went in to student health.  NP RXed 10 days doxycycline, 100 mg PO BID, sent me to ER.  Had an ultrasound, confirmed it was epididymitis plus a hydrocele.  They gave me a shot of ceftriaxone and told me to continue with the doxycycline.  The ceftriaxone helped a great deal (swelling went down almost immediately) but as I continued the course of doxy the problem began to get worse again.  

I followed up with a urologist.  He put me on Cipro for 14 days, 500 mg PO BID.  By day 11, the problem finally seemed totally resolved.  5 days after stopping the Cipro, I can feel it beginning to come back.

I have just started isotretinoin treatment for acne.  Looking for suggestions that wouldn't require d/c'ing the isotretinoin.

Any thoughts?

[Dallasfan]

Interesting question. There has been some papers published concerning the developement of fluoroquinolone resistance in Chlamydia trachomatis but not in the pneumonia species. These studies were all done in the lab. Apparently there is an amino substitution that occurs in the GYR A  protein of the Chlamydia.  One reason I don`t recommend treating genital Chlamidial infections with fluoroquinolones.

[Will836]

Thanks for the input, Grace.  Epididymitis is often caused by strains of chlamydia and gonorrhea, or by coliform bacteria in homosexual men.  I posted here because I was curious if anyone knew about fluoroquinolone resistance in C. Trachomatis (levofloxacin vs. ciprofloxacin, bacteriostatic or bactericidal effects), or anything along those lines.

For anyone reading this in a similar position, I followed up with my urologist over the phone, who advised that a recurrence of swelling and pain after d/c'ing antibiotics is typical with epididymitis and a NSAID like ibuprofen should be all that's needed.  After a week, if the pain has not subsided, he advised an in-person consultation.

[gracefromHHP]

you need to continue to follow up on this with your urologist. this is not a std issue so this isn't the proper forum for any follow up questions.

Since you've been on a lot of antibiotics too, I recommend a probiotic like culturelle ( google it ) to keep your bowel flora healthy before more issues start from antibiotic use. You can find it at walmart and target most times.



grace