Etiology and clinical features of acute epididymo-orchitis

Seventy-nine patients presenting with acute epididymo-orchitis (AEO) were prospectively analyzed in order to study the etiology and pattern of the disease. Bacteriological, serological, biochemical, imaging, and endoscopic studies were undertaken to look for urinary tract infection (UTI), brucellosis, gonorrhea, diabetes mellitus (DM), bladder outflow obstruction (BOO), and other urinary tract pathology (UP). Thirty-nine patients also underwent, on their urethral scrapings, the direct immunofluorescence test with monoclonal antibodies (DIF) for Chlamydia trachomatis. The mean age was 44 +/- 20.4 years (median = 40 years) and 43% of the patients were married. Only one patient had urethritis, which nongonococcal. Thirty-five percent presented with pyrexia and only one had brucellosis. Fifty-three percent had significant pyuria but only 22 patients (285) had bacteriuria and E. coli was the etiological agent in 19/22 patients (86%). Eleven out of 39 patients (28%) were positive for Chlamydia trachomatis. BOO, UP, and DM were encountered in 25%, 12.5% and 10%, respectively, but no obvious cause was detected in 26 (33%) patients. Recurrent AEO, abscess formation and bacteremia occurred in 21.5%, 4%, and 1%, respectively. Recurrent AEO was significantly more common in married patients than in single patients (P<0.05) and BOO was significantly more common in patients above the age of 50 years. It is concluded that an underlying cause of AEO could be identified in only two-thirds of the patients. In the remaining one-third, the etiology continues to be obscure and investigations for viral and fastidious infections may be of help in future studies. Endoscopy and urodynamic studies for BOO can be restricted to the elderly patients to cut down the cost of management of this fairly common emergency.