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

Abstract

Objective: This study represents the first direct comparison of management of epididymo-orchitis (EO) by Accident and Emergency (A&E), Urology and Genito-Urinary Medicine (GUM) departments in a large tertiary care centre, and their compliance with international guidelines. Methods: Case notes of patients with EO who attended A&E, Urology and GUM between January and June 2014 were analysed retrospectively. Results: A total of 127 men were seen (median age: 33, range: 15-79). Forty-four attended A&E (median age: 35), 30 Urology (median age: 37), and 53 GUM (median age: 31).MSU was sent in 17/44 (38.6%) of A&E, 11/30(36.7%) of Urology, and 35/53(66%) of GUM patients. Fifty-three of 53 (100%) of GUM, 14/44 (31.8%) of A&E and four of 30 (13.3%) of Urology patients had chlamydia and gonorrhoea NAAT testing.Of these, 90.9% of A&E, 93.3% of Urology and 100% of GUM patients were prescribed antibiotics. Twelve A&E and one Urology patient were referred to GUM. Conversely, only three of 11 A&E and zero of five GUM patients aged over 50 were referred for urological follow-up. Conclusion: The management of EO, especially in younger men at risk of STIs by A&E and Urology, and older men at risk of urological problems by GUM, is an area for significant improvement. Closer co-operation between departments, unifying local management protocols, abandoning the traditional demographic divide, and ensuring effective referral pathways are essential to improving care.