Acute epididymitis revisited: impact of molecular diagnostics on etiology and contemporary guideline recommendations

Adrian Pilatz¹, Hamid Hossain², Rolf Kaiser³, Annette Mankertz⁴, Christian G Schüttler⁵, Eugen Domann², Hans-Christian Schuppe⁶, Trinad Chakraborty², Wolfgang Weidner⁶, Florian Wagenlehner⁶

Acute epididymitis is a common infectious disease, with the etiology unknown in about 30% of cases, and the treatment is based on guidelines from studies published over 15 years ago. The purpose of this study is to investigate the etiology of acute epididymitis and provide data to guide antimicrobial therapy and clinical management.

Guidelines state that in young, sexually active men with epididymitis, Chlamydia trachomatis is the most common pathogen, whereas in older men with benign prostatic hyperplasia or other urinary issues, uropathogens such as Escherichia coli are most likely involved. However, this study found that enteric pathogens were responsible for most cases, including those in patients under 35 years of age.

According to these results, the assumption that young men primarily harbor sexually transmitted infections is not accurate, as enteric pathogens were identified in one-third of the cases. This study challenges the conventional approach of linking STIs to patients under 35 years old and enteric pathogens to those over 35. Although a sexual history suggestive of STIs was significantly associated with the actual presence of STIs, about half of STI pathogens were detected in sexually active patients without a history suspicious for STIs. This shows the importance of not only asking for a sexual history but also screening all sexually active patients for STIs.

Lastly, the study’s susceptibility assessments indicated that more than 85% of bacterial strains were susceptible to both fluoroquinolones and third-generation cephalosporins. Considering the lack of antichlamydial activity in third-generation cephalosporins, the study recommends fluoroquinolones with antichlamydial activity as the preferred therapy. This study presents a different approach to managing and treating acute epididymitis.

Reference:

Pilatz, A., Hossain, H., Kaiser, R., Mankertz, A., Schüttler, C. G., Domann, E., Schuppe, H. C., Chakraborty, T., Weidner, W., & Wagenlehner, F. (2015). Acute epididymitis revisited: impact of molecular diagnostics on etiology and contemporary guideline recommendations. European urology, 68(3), 428–435. https://doi.org/10.1016/j.eururo.2014.12.005

Acute-Epididymitis-Revisited-Etiology-and-Guideline-Recommendations