American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment for infectious epididymitis in older men and those who practice anal intercourse?

1. Ceftriaxone and doxycycline

2. Ceftriaxone and fluoroquinolone

3. Fluoroquinolone and doxycycline

4. Amoxicillin and azithromycin

The correct answer is: Ceftriaxone and fluoroquinolone

The recommended treatment for infectious epididymitis in older men and those who practice anal intercourse is a combination of ceftriaxone and a fluoroquinolone. This recommendation is based on the need to cover for potential bacterial pathogens that are common in these patient populations. In older men, the etiology of epididymitis is often related to urinary pathogens, including Escherichia coli. The fluoroquinolone provides robust coverage against these Gram-negative organisms. Meanwhile, ceftriaxone is effective against Neisseria gonorrhoeae, making it particularly pertinent for those who engage in anal intercourse where the risk of sexually transmitted infections is elevated. This dual treatment therefore addresses both potential urinary and sexually transmitted pathogens effectively. In summary, the combination of ceftriaxone and a fluoroquinolone ensures broad-spectrum coverage for the likely infections causing epididymitis in these specific groups of patients.