The Role of Chlamyudia trachomatis in Epididymitis

Abstract

Microbiological studies have identified an infective micro-organism in 28 of 54 patients (52%) with epididymitis. Chlamydia trachomatis was the commonest infection isolated, occurring in 15 patients. An additional 17 patients (31%) who were culture negative had serological evidence which suggested recent chlamydial infection. Most patients with chlamydia were under 26 years of age, in contrast to patients over 35 years, in whom coliform infections predominated. Of the 12 consorts of patients with chlamydial epididymitis who were screened, nine were also positive for this micro-organism. These findings have important implications in the management of epididymitis, especially in young men.

Acute epididymitis

“…C. trachomatis is the commonest bacterial sexual infection in developed countries. Its predominance in the aetiology of acute epididymitis in men aged < 35 years, and the importance of Gram‐negative rods in those > 35 years, has been subsequently confirmed in numerous other studies [20–23]. This age relationship seems to be retained in the developing world [24].…”

“…In confirmed or suspected cases of chlamydial epididymitis, the importance of treating sexual partners is emphasized by numerous authors [2,21,22,80]. In a prospective study of 49 men aged < 35 years with epididymitis, 80% of female partners screened were positive for Chlamydia , regardless of whether or not the male partner's chlamydial test was positive [80].…”

Management of epididymo-orchitis in primary care: results from a large UK primary care database

“…2 Existing guidelines are based on a clinical consensus that in men under 35 years, epididymo-orchitis is most commonly caused by a sexually transmitted pathogen such as Chlamydia trachomatis or Neisseria gonorrhoeae. [3][4][5][6][7] In older men, the infection is more likely to be due to non-sexually transmitted enteric Gram-Novel organisms, such as Mycoplasma genitalium, which are not included in testing regimes, may be involved in such cases. The data underlying this conventional divide at 35 years may, however, be questioned, as they are based on small studies in selected populations.…”

“…The data underlying this conventional divide at 35 years may, however, be questioned, as they are based on small studies in selected populations. [3][4][5][6][7] Guidelines from the US and UK suggest a detailed testing schedule, involving C. trachomatis, N. gonorrhoeae, urethral swabs or firstvoid urine culture, and midstream urinalysis (MSU), followed by antibiotics as indicated by history, with doxycycline for likely C. trachomatis infections, ceftriaxone/ciprofloxacin followed by doxycycline for N. gonorrhoeae infections, and ofloxacin/ciprofloxacin for enteric organisms. 8,10 Effective treatment and management of epididymoorchitis is important for clinical and public health reasons.…”

Epididymitis: Diagnosis and treatment

“…Do 80% slučajeva epididimitisa ima bakterijsku etiologiju [10][11][12][13], mada su velike epidemiološke studije potvrdile jasnu bakterijsku etiologiju u manje od 25% osoba sa kliničkim znacima epididimitisa [2,9]. Kod muškaraca do 35. godine života Chlamydia trachomatis uzrokuje najveći broj epididimitisa, mada se kod većine (čak do 90%) ne može dokazati prusustvo ove bakterije [10,[14][15][16]. Najčešći uzročnici epididimitisa kod muškaraca starijih od 35 godina jesu crijevne bakterije, među kojima prednjači Escherichia coli.…”