The evaluation and treatment of acute epididymitis in a large university based population: are CDC guidelines being followed?

PURPOSE: To review the evaluation and treatment of epididymitis in a contemporary population and evaluate adherence to Centers for Disease Control (CDC) guidelines.

MATERIALS AND METHODS: From 1999 to 2005, 870 patients from a single institution were diagnosed with epididymitis. Information regarding patient demographics, diagnostic evaluation, and treatment was reviewed. Adherence to CDC guidelines for the treatment of acute epididymitis was evaluated.

RESULTS: A total of 455 men between 3 and 88 years met inclusion requirements for acute epididymitis. Seven percent of pediatric patients (< 18 years) and 29.5% of adult patients (> or = 18 years) undergoing urine culture demonstrated bacterial growth. Twelve percent of adult patients with urethral swab PCR performed for Chlamydia trachomatis had positive results. A bacterial etiology for epididymitis was documented in 6.6% of pediatric patients and 28% of adult patients who were tested by urine culture and/or urethral swab for C. trachomatis. Less than 35% of adult men underwent the appropriate CDC work-up. Fifty percent of patients, 18-35 years and 85% of patients, > 35 years were prescribed an effective treatment according to CDC guidelines. Patients were less likely to be admitted to the hospital (100 vs. 2.3%) and more likely to be treated with antibiotics than in previously published series (97 vs. 75%).

CONCLUSIONS: CDC guidelines for the evaluation and treatment of acute epididymitis were followed in less than 35% of patients seen in a university based health care system. Despite a paucity of documented urinary infection, 97% of adult men are treated empirically with antibiotics often not in accordance with CDC guidelines.