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Treatment of Acute Epididymitis4/4/2000
Treatment of Acute Epididymitis A systematic review of studies completed in the last 11 years for the treatment of acute epididymitis identified 1534 records, of which 29 were assessed for eligibility, and only 1 study met the criteria for inclusion. This highlights the need for more prospective studies evaluating treatment regimens for acute epididymitis.To get more news about Epididymitis treatment, you can visit our official website.

Epididymitis refers to inflammation of the epididymis, whereas epididymo-orchitis refers to inflammation of both the epididymis and testes.1 Acute epididymitis is a clinical syndrome of pain, swelling, and inflammation of the epididymis that lasts less than 6 weeks.2 The prevalence of epididymitis is unknown because it is not a reportable condition in most jurisdictions. A 2002 study reported approximately 600,000 new cases of epididymitis per year in the United States, most of which occurred in men between 18 and 35 years of age.3 A 2005 Canadian study found that 1% of men presenting to a Canadian outpatient urology clinic had epididymitis.4 Epididymitis may be caused by infectious and non-infectious processes.1 The etiology of bacterial epididymitis is dependent on age, sexual practices, and the presence of urinary tract abnormalities or history of instrumentation.1,5,6 Several earlier studies linking sexually transmitted pathogens to acute epididymitis were conducted in sexually transmitted infection (STI) centers and in army hospitals.5,7,8 This has led to the consensus that in men younger than 35 years, epididymo-orchitis is often associated with sexually transmitted organisms such as Chlamydia trachomatis (CT) or Neisseria gonorrhoeae (NG) while in men over 35 years of age, it is often caused by non-sexually transmitted enteric organisms, such as Escherichia coli and Proteus sp.

In this group, the epididymis usually becomes infected in the setting of bacteruria secondary to bladder outlet obstruction (eg, benign prostatic hyperplasia), prostate biopsy, urinary tract instrumentation or surgery, systemic disease, and/or immunosuppression.6 In addition, men who are the insertive partner during unprotected anal intercourse may also develop acute epididymitis from enteric organisms (eg, Escherichia coli).5 Treatment recommendations for epididymitis are largely based on etiologic studies conducted in the 1980s and 1990s9–11 and the last prospective treatment trial of epididymitis published in 1999.12 Selection of presumptive therapy is therefore based on risk for chlamydia and gonorrhea and/or enteric organisms with the goals of treatment of acute epididymitis to achieve: (1) microbiologic cure, (2) improvement of signs and symptoms, (3) prevention of transmission of CT and NG to others, and (4) a decrease in potential complications of CT/NG epididymitis (eg, infertility and chronic pain).

13 Current guidelines for presumed sexually transmitted epididymitis recommend ceftriaxone 250 to 500 mg by intramuscular injection in a single dose in combination with doxycycline 100 mg orally twice daily for 10 to 14 days.13–17 For epididymitis, most likely caused by enteric organisms, alternate treatment options include ofloxacin 200 to 300 mg orally twice daily for 14 days, levofloxacin 500 mg orally once daily for 10 days, or ciprofloxacin 500 mg orally daily for 10 days.13–15 The Centers for Disease Control and Prevention guidelines also include a separate recommendation for the treatment of acute epididymitis caused by sexually transmitted and enteric organisms (eg, men who practice insertive anal sex) to include a combination of ceftriaxone plus levofloxacin or ofloxacin.

13 For patients reporting allergies or sensitivities to cephalosporin (ceftriaxone) and/or tetracycline (doxycycline) antibiotics, the only cited alternate options are quinolone antibiotics, ofloxacin, and levofloxacin; ofloxacin was recently withdrawn from the Canadian market and is not available in the United States.3,18 The impact of resistance to antibiotics used to treat STIs, especially gonorrhea, is also unknown. All primary experimental (randomized and non-randomized controlled trials) and observational studies (cohort, case-control,) reporting antibiotic treatment(s) in adolescent (13–19 years) and adult (>19 years) males with acute epididymitis due to sexually transmitted or enteric pathogens were included. Interventions comprised of any antibiotic used in the treatment of epididymitis as compared with other antibiotics, placebo, no therapy or other dosing regimens of the same antibiotic. Only English and French language studies were included.

We included published peer-reviewed studies; reference lists of relevant articles were hand-searched. Cross-sectional studies, case reports, case series, modeling studies, letters, comments, opinion pieces, narrative reviews, and audits evaluating adherence to treatment guidelines were excluded. The following databases were searched: Ovid MEDLINE/PubMed, Ovid EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL Plus with Full-text, Web of Science Core Collection, Scopus, ProQuest Dissertations & Theses Global, Clinicaltrials.gov, and Health Canada Trials Database from January 1, 2006, to August 6, 2017. The search period was dated back to 2006, because this was when the Canadian Guidelines on Sexually Transmitted Infections were last updated. Table 1 provides an overview of the study protocol.
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