What is the treatment of epididymitis because of tuberculosis
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Treatment of Tuberculous Epididymitis
Tuberculous epididymitis is a form of genitourinary tuberculosis (GUTB), and its management combines anti-tuberculosis chemotherapy with selective surgical intervention.
1. Anti-Tuberculosis Drug Therapy (Primary Treatment)
The cornerstone of treatment is a standard anti-tuberculosis (ATT) regimen, identical to that used for pulmonary TB:
| Phase | Duration | Drugs |
|---|---|---|
| Intensive phase | 2 months | Isoniazid (H) + Rifampicin (R) + Pyrazinamide (Z) + Ethambutol (E) |
| Continuation phase | 4 months | Isoniazid (H) + Rifampicin (R) |
- Total duration: 6 months (standard DOTS regimen — 2HRZE / 4HR)
- A full course must be completed even if there is no evidence of disease elsewhere in the body.
- Secondary (reactive) tuberculous epididymitis may resolve when the primary focus (e.g., renal TB) is treated appropriately.
According to Bailey and Love's Short Practice of Surgery, 28th Ed. (p. 1589): "A course of antituberculous chemotherapy should be completed even if there is no evidence of disease elsewhere."
2. Monitoring Response
- Clinical response (reduction in swelling, tenderness) is expected within 2 months of initiating ATT.
- Antituberculous drugs are noted to be less effective in genital TB compared to urinary TB, so close monitoring is essential.
3. Surgical Treatment
Surgery is indicated when there is failure to respond to medical therapy:
| Indication | Procedure |
|---|---|
| No resolution after 2 months of ATT | Epididymectomy |
| Involvement/destruction of testis, or orchitis | Orchidectomy |
| Scrotal abscess (cold abscess) | Drainage |
| Bilateral disease causing infertility concern | Individualized |
Bailey and Love's (p. 1589): "If resolution does not occur within 2 months, epididymectomy or orchidectomy is advisable."
4. Additional Considerations
- Investigate for other GUTB sites: Renal TB (most common primary site), bladder, vas deferens, seminal vesicles. Urine culture for AFB, IVU/CT urography, and cystoscopy may be warranted.
- Genitourinary TB can cause bilateral nodular induration of the epididymis and nodularity of the vas deferens, and may result in scrotal abscesses that — unlike pyogenic abscesses — tend to be cold and indolent (Bailey and Love's, p. 1470).
- Infertility: Bilateral epididymal involvement can cause obstructive azoospermia; this should be discussed with the patient.
- Drug-resistant TB: If MDR-TB is suspected, a second-line regimen guided by susceptibility testing is required (18–24 months).
- Steroids are not routinely used in GUTB unless there is severe ureteric stricture complicating renal TB.
Summary: Treat with standard 6-month ATT (2HRZE/4HR). If the lesion does not resolve within 2 months, proceed to epididymectomy or orchidectomy. Always complete the full drug course regardless of apparent resolution.
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