Management of Acute Epididymitis: Are European Guidelines Being Followed?
Introduction
Acute epididymitis is a common and increasing problem presenting to Urological surgeons and Genitourinary physicians, both as an emergency and in the clinic. Peak incidence is in the third decade, with 70% of cases occurring between 20 and 39 years [1], [2]. In men aged 35 years or less, the infection is usually sexually-transmitted with Chlamydia trachomatis isolated in up to 85% of cases using DNA amplification techniques, followed by Neisseria gonorrhoeae [3], [4]. In contrast, epididymitis in patients over this age is predominantly caused by non-sexually transmitted enteric pathogens entering the urinary tract.
European Association of Urology (EAU) and other guidelines for the management of acute epididymitis clearly define investigation and treatment protocols dependent on the suspected pathogen [5], [6]. This study aims to explore the management preferences of Urological surgeons in two regions of the United Kingdom to assess whether these guidelines are being followed for young patients.
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Methods
A postal questionnaire survey was conducted of Consultants, Specialist Registrars and Associate Specialists in Urology in the Wessex and South West regions of the United Kingdom. Participants were asked about their management of acute epididymitis, defined as symptoms of less than six weeks duration, in those aged 35 years or under. They were questioned regarding the taking of a detailed sexual history, investigations for concurrent urethritis, choice of first-line antibiotics and whether this
Results
One hundred questionnaires were distributed, of which 80 were returned completed. All bar one specialist are consulted by patients under the age of 35 with acute epididymitis (99%) and of these, 41 (52%) routinely take a detailed sexual history. Only 14 (18%) perform urethral swabs or other investigations to detect concurrent urethritis, namely a mid-stream specimen of urine and molecular techniques.
Quinolones are the most commonly prescribed first-line antibiotic by 56 (71%) Urologists, with
Discussion
The number of cases of Chlamydia presenting to Genitourinary medicine clinics in the United Kingdom has more than doubled since 1995 and is currently rising at a rate of 9% per year in males [7]. This sustained increase will affect the number of young men with acute epididymitis consulting Urologists, whose management is inconsistent.
In a cohort where a sexually-transmitted disease is the most likely diagnosis, only half of respondents in our survey routinely take a detailed sexual history and
Acknowledgements
We are particularly grateful to Mr John Hammonds, Plymouth, UK and thank the Wessex and South West Urologists for completing our survey.
NED formulated the study in conjunction with JPD. All authors were involved in data analysis and writing the paper.
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