Advances in the antibiotic management of epididymitis

ABSTRACT

Introduction

Acute epididymitis is commonly encountered and typically presents acutely within a wide clinical spectrum. Most cases of acute epididymitis are caused by bacterial infection, most often by sexually transmitted organisms and urinary pathogens. Current treatment regimens remain empirical, although recent advances using modern diagnostic techniques support a change in the management paradigm.

Areas covered

The choice of the initial antibiotic regimen is empirical and based on the most likely causative pathogen, whether sexually transmitted, enteric, or other. Adherence of clinical practice remains short of available guidance, which may be improved by thorough clinical and microbiologic assessment, supported by a knowledge of the commonly associated pathogenic organisms, and the appropriate choice of tests required for their identification. The use of advanced microbiology techniques and studies of current practice provide new insights that have challenged traditional management paradigms. The authors discuss these points and provide their expert perspectives on its treatment and future developments.

Expert opinion

Relatively sparse direct trial data exists on antimicrobial treatments for acute epididymitis. Much of the presently available guidance is derived from previous guidance recommendations, knowledge of antimicrobial activities of specific agents, and treatment outcomes in uncomplicated infections. Identification of specific pathogens and prescribing accuracy is dependent on the extent to which cases are investigated and is therefore variable.

KEYWORDS:

• Acute epididymitis
• acute testicle
• scrotal pain
• bacterial infections
• anti-bacterial agents

Article highlights

• There remains significant variation in the management of acute epididymitis

• Choice of antimicrobial agents requires a comprehensive microbiology workup to identify specific pathogens.

• Modern diagnostic microbiology techniques can significantly improve the diagnostic yield.

• Use of age criteria for determination of likely aetiology is unreliable

• The condition presents an unmissable opportunity for STI screening, contact notification, and treatment

• There is a dearth of direct evidence for use of antimicrobial agents in epididymitis and an urgent need for well-designed randomised clinical trials.

Declaration of interest

J Khastgir has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.