Introduction: Acute epididymitis (AE) is the fifth most common urological diagnosis in men aged 18-50yrs old.. The main causative pathogens in patients under35 yrs. are sexually transmitted whereas in patients over 35 yrs. Are enteropathogens. Polymerase chain reaction (PCR) test of a urine sample, taken from first voided urine(FVU), is considered to be the test of choice for the diagnosis of sexually transmitted infections (STI). Various studies have shown that the detection rate in this test in all patients with acute epididymitis is low. Moreover, the data is quite limited regarding the detection rate in patients under 35 yrs. The purpose of this study is to evaluate the etiology of AE in young men and the detection rate of PCR urine test among patients between ages 14-35yrs who are considered to be the main high-risk group for STI.
Methods: We conducted a retrospective review of antibiotic-naïve patients under 35 yrs. between January 2017 – April 2021,with first diagnosis of acute epididymitis and without any previous urological intervention or antibiotic use. All patients underwent physical examination and had blood tests [white blood cells (WBC) count, C-reactive protein(CRP)],urine culture and urine- PCR test for STI. All patients underwent testicular ultrasound to confirm the diagnosis. A comprehensive analysis of the data was performed, including the effect of the patient's ethnicity, the time of the day that when the urine sample for PCR-test was taken, urine culture, the clinical and laboratory presentation(fever, leukocytosis, and CRP)and the STI pathogen detected . All patients were treated according to current guidelines for AE.
Results: The study included 97 patients with a mean age of 26 yrs.(range 17-35).A pathogen in urine PCR test was detected in 23.7% of the patients (23/97), and ,Chlamydia was the most common (17/23,74%).Positive urine culture was positive uncommon(only 4/97,4%) .Ethnicity had no significant effect on the detection rate for STI(p-Value> 0.05) .Most urine samples were taken at evening time in both groups ( detected and non-detected in Urine-PCR Test )with no statistic difference regarding timing of urine PCR sampling (p=0.837).Most patients were presented without fever or elevated inflammatory lab. parameters.
Conclusions: The detection rate of STI pathogens in urine- PCR among young patients with confirmed AE was lower than expected. Fever and increased inflammatory inflammatory lab. parameters are not common for epididymitis in young patients. Our findings raises two major questions: First – is the low detection rate in urine –PCR test a result of the timing of urine sampling and second – which other etiologies might cause AE? More wide prospective studies should be conducted in order to establish answers to these very significant questions to clarify of etiology of AE.