Management of epididymo-orchitis in Genitourinary Medicine clinics in the United Kingdom's North Thames region 2000

Abstract

A questionnaire survey and case notes audit reviewing management of epididymo-orchitis (E-O) by 34 Genitourinary Medicine (GUM) clinics located in the North Thames was undertaken. Twenty-two clinics (65%) returned completed questionnaires and audited a total of 83 newly diagnosed cases. All participating clinics offer microscopy of urethral smears and screening for Neisseria gonorrhoeae and Chlamydia trachomatis to all patients, regardless of age. However, greater numbers of clinics would offer routine microbiology of mid-stream urine (MSU) samples (20/22, 91% versus 16/22, 73%) and scrotal ultrasound (5/22, 23% versus 1/22, 5%) to patients aged over 35, compared with men under 35. Half of the cases audited were due either to sexually transmitted infections (STIs) (41/83, 49%), or associated with ascending urinary tract infections (4/83, 5%). No obvious infectious cause was identified for 38/83 cases (46%). Reported management was appropriate for the causative conditions diagnosed and accorded with the UK National Guidelines for this and related conditions.

Management of epididymo-orchitis in three different clinical settings: Streamlining pathways and improving care

“…Particular shortfalls are evident in the management of patients in the extremes of ages: the younger men at risk of STIs by A&E and Urology, and the older men at risk of functional and anatomical urological problems by GUM. Existing literature supports the findings presented here, 6,10 suggesting that the issues surrounding management of EO highlighted in this report are common to the departments across the country.…”

“…These findings are in line with past studies, reporting quinolones as the standard treatment for EO in secondary care, 10 and doxycycline as the norm in GUM clinics. 6 Concerns regarding prescribing ciprofloxacin to patients in whom chlamydial aetiology of EO has not been ruled out are well established: although ciprofloxacin has been shown to have anti-chlamydial activity in vitro , unlike other fluoroquinolones, its clinical efficacy is variable and it does not eradicate the infection in vivo . 18 It is therefore alarming that the highest rates of ciprofloxacin prescribing were found in the departments with the lowest rates of sexual history taking and STI testing.…”

“…The existing literature, however, suggests significant differences in the characteristics and quality of management of EO across different services, with one survey of UK urologists indicating low compliance with guidelines, 10 in contrast to another survey of GUM departments reporting near-complete adherence. 6…”

“…[2][3][4] The extent of sterile or idiopathic cases is unclear, 5 but no causative infective agent is identified in up to 46% of cases. 6 Organisms, such as mumps, tuberculosis (TB), Brucellosis, Candida, Mycoplasma genitalium, Ureaplasma urealyticum, along with conditions such as testicular tumours, autoimmune disorders, Behcet's disease and amiodarone use, may be involved in such cases; 6 however, these are rare and not routinely tested for on initial presentation. Testicular torsion remains the major differential diagnosis, as significant delay in surgical intervention adversely affects the prognosis.…”

Epididymo-orchitis and epididymitis: a review of causes and management of unusual forms

“…As an alternative to cipro¯oxacin, ceftriaxone 250 mg intramuscularly (im) can be given 15,42 . It is important to be aware of local resistance patterns for N. gonorrhoeae.…”