MICROBIOLOGY OF ACUTE EPIDIDYMITIS IN A DEVELOPING COMMUNITY

Objective-To investigate the aetiology of acute epididymitis in a deve loping community with a view of determining appropriate antimicrobial therapy. Setting-City Health Sexually Transmitted Diseases Clinic, Kin g Edward VIII Hospital, Durban, South Africa. Participants-144 adult m en with clinically diagnosed acute epididymitis. Method-Endourethral s wab and midstream urine (MSU) specimens were processed to detect sexua lly transmitted pathogens and urinary tract infections. Results-The ma jority of patients (93%) were less than 35 years of age. Neisseria gon orrhoeae and/or Chlamydia trachomatis were detected in 78% of patients : N gonorrhoeae in 57%, C trachomatis in 34% and both in 13%. Escheric hia coli was cultured more frequently from MSU specimens of older pati ents, 30% versus 3%. In 53% of patients urethritis was diagnosed by th e presence of inflammatory cells in endourethral smears in the absence of a visible urethral discharge. Conclusion-In our setting of a busy clinic with limited facilities, we recommend the performance of a Gram stain on endourethral specimens from patients with acute epididymitis . If inflammatory cells and Gram negative diplococci are detected, tre atment with antimicrobial agents to cover both penicillinase-producing N gonorrhoeae strains and C trachomatis is recommended. If Gram negat ive diplococci are not detected in the presence of microscopic evidenc e of urethritis, treatment for chlamydial infection alone is recommend ed.