World J Mens Health.  2013 Apr;31(1):53-57.

The Relationship between Clinical Symptoms and Urine Culture in Adult Patients with Acute Epididymitis

• Kim SD
• Kim SW
• Yoon BI
• Ha US
• Kim SW
• Cho YH
• Sohn DW

Abstract

PURPOSE
We evaluated adult patients with acute epididymitis to identify the frequency of actual sexual contacts and the causative organism, and compared clinical examinations, degrees of manifested symptoms, and radiological test results.
MATERIALS AND METHODS
We reviewed the medical records of 65 patients older than 18 years presenting with acute epididymitis who had been treated between 2002 and 2011. Scrotal ultrasonography, urinalysis, and urine culture were performed to diagnose the acute epididymitis. Patients were divided into negative (n=45) and positive (n=20) urine culture groups. Then the latter groups were subdivided into a sexually transmitted organism (STO) culture group (n=13) and a non-STO (n=7) culture group. Data on any history of sexual contact, scrotal pain and tenderness, symptoms of urethritis (discharge, dysuria, urethral burning, or irritation), and lower urinary tract symptoms (dysuria, frequency, and urgency of urination) were obtained from all of the subjects.
RESULTS
Patients in the positive urine culture group were significantly younger than those in the other group (p=0.224) and were more likely to have a history of sexual contact at least two weeks prior to onset of epididymitis (p=0.012). They had also a significantly enlarged epididymal head and significantly more severe complaints of pain or tenderness than those of latter group (p=0.348, p=0.288). However, the difference in these measures between the STO and non-STO group was not significant, except in the case of age (p=0.044).
CONCLUSIONS
Patients of the positive urine culture group with acute epididymitis were significantly younger and more sexually active than the others. They also had severe pain or tenderness and an enlarged epididymal head. There was a close association between clinical symptoms, a positive urine culture, and ultrasonographic findings.

Keyword

Epididymis; Infection; Urine; Culture

MeSH Terms

Adult
Burns
Dysuria
Epididymis
Epididymitis
Head
Humans
Lower Urinary Tract Symptoms
Male
Medical Records
Urethritis
Urinalysis

Reference

1. Berger RE, Alexander ER, Monda GD, Ansell J, McCormick G, Holmes KK. Chlamydia trachomatis as a cause of acute "idiopathic" epididymitis. N Engl J Med. 1978. 298:301–304.

2. De Jong Z, Pontonnier F, Plante P, Gautier JR, Ioualalen A, Archambaud M, et al. The frequency of Chlamydia trachomatis in acute epididymitis. Br J Urol. 1988. 62:76–78.

3. Anthonisz M. Assessing the impact: the National Chlamydia Screening Programme. Br J Nurs. 2009. 18:246–251.

4. Geisler WM, Krieger JN. Holmes KK, Sparling PF, Stamm WE, editors. Epididymitis. Sexually transmitted diseases. 2008. New York: McGraw-Hill Medical;1127–1145.

5. Oh DK, Kim SJ, Ahn HS. Experiences of 313 cases of acute scrotum: properties of acute epididymitis and differential diagnosis of testicular torsion. Korean J Urol. 2002. 43:624–630.

6. Park CH, Im JK, Kim KK, Park HW. Clinical characteristics of acute epididymitis in children and adults. Korean J Urol. 1999. 40:674–676.

7. Melekos MD, Asbach HW. Epididymitis: aspects concerning etiology and treatment. J Urol. 1987. 138:83–86.

8. Hawkins DA, Taylor-Robinson D, Thomas BJ, Harris JR. Microbiological survey of acute epididymitis. Genitourin Med. 1986. 62:342–344.

9. Hoosen AA, O'Farrell N, van den Ende J. Microbiology of acute epididymitis in a developing community. Genitourin Med. 1993. 69:361–363.

10. Siegel A, Snyder H, Duckett JW. Epididymitis in infants and boys: underlying urogenital anomalies and efficacy of imaging modalities. J Urol. 1987. 138:1100–1103.

11. Park HC, Park HJ, Park NC. Adenomatoid tumor of the epididymis. Korean J Androl. 2003. 21:111–113.

12. Lee SW, Jung HW, Kim SY, Kim H, Yang DY, Cho SJ. Clear cell papillary cystadenoma of the epididymis associated with multiple renal and pancreatic cysts. Korean J Androl. 2007. 25:141–144.

13. Lewis AG, Bukowski TP, Jarvis PD, Wacksman J, Sheldon CA. Evaluation of acute scrotum in the emergency department. J Pediatr Surg. 1995. 30:277–281.

14. Höppner W, Strohmeyer T, Hartmann M, Lopez-Gamarra D, Dreikorn K. Surgical treatment of acute epididymitis and its underlying diseases. Eur Urol. 1992. 22:218–221.

15. Hutson JM, Dewan PA. Acute epididymitis in boys: are antibiotics indicated? Br J Urol. 1997. 80:970–971.

16. Ji YH, Park SC, Lee SK, Choo HS, Kim J, Choi HJ, et al. Adenomatoid tumor between the epididymis and the testis. Korean J Androl. 2008. 26:240–243.

17. National guideline for the management of epididymoorchitis. Clinical Effectiveness Group (Association of Genitourinary Medicine and the Medical Society for the Study of Venereal Diseases). Sex Transm Infect. 1999. 75:Suppl 1. S51–S53.