Introduction: Epididymitis remains a common cause of acute testicular pain in children. Except for epididymitis caused by sexually transmitted infections (STIs), management strategies remain inconsistent, with no clear guidelines. Herein, we sought to understand treatment patterns and related outcomes of children with non-STI-associated epididymitis seen by an academic pediatric urology practice.

Methods: A single-center, retrospective review was completed among all patients referred to a pediatric urology group with presumed diagnosis of non-STI-associated epididymitis/-orchitis from 2015–2020. Data on referring emergency department (ED) or family physician workup were reviewed. Logistic regression analyses and Pearson Chi-squared tests were used to assess associations between patient presentation, prescription of antibiotics (Abx), and epididymitis recurrence.

Results: A total of 127 patients with epididymitis were included; 70.1% were referred from a dedicated pediatric ED. Among all patients, 56.7% had a urinalysis (UA) as part of the initial workup, while 48.8% were prescribed Abx. Patients not referred from a dedicated pediatric ED were 2.7 times more likely to receive Abx for management of epididymitis (95% confidence interval [CI] 1.2–5.9, p=0.01). Having a UA was not significantly associated with Abx, while having a positive UA was associated with Abx treatment (odds ratio 3.6, 95% CI 1.2–6.0, p=0.01) irrespective of culture results. Twelve patients had recurrent epididymitis, which was not associated with receipt of Abx (p=0.49).

Conclusions: While practice patterns vary, Abx are widely prescribed to children diagnosed with non-STI-associated epididymitis based on UA results, which has unknown utility for epididymitis diagnosis and management. Prospective data are needed to identify clear guidelines for managing pediatric epididymitis.