title: Management of epididymo-orchitis in primary care: results from a large UK primary care database.
abstract: BACKGROUND
  Epididymo-orchitis is a common urological presentation in men but recent incidence data are lacking. Guidelines for management recommend detailed investigation and treatment for sexually transmitted pathogens, such as Chlamydia trachomatis. Data from secondary care indicate that these guidelines are poorly followed. It is not known how epididymo-orchitis is managed in UK general practice.
  
  
  OBJECTIVE
  To estimate the incidence of cases of epididymo-orchitis seen in UK general practice, and to describe their management.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  UK general practices contributing to the General Practice Research Database (GPRD).
  
  
  METHODS
  Men, aged 15-60 years, consulting with a first episode of epididymo-orchitis between 30 June 2003 and 30 June 2008 were identified. All records within 28 days either side of the diagnosis date were analysed to describe the management of these cases (including location) and to compare this management with guidelines.
  
  
  RESULTS
  A total of 12 615 patients with a first episode of epididymo-orchitis were identified. The incidence was highest in 2004-2005 (25/10 000) and declined in the later years of the study. Fifty-seven per cent (6943) of patients were managed entirely within general practice. Of these, over 92% received an antibiotic, with ciprofloxacin being the most common one prescribed. Only 18% received a prescription for doxycycline. Most men, including those under 35 years, had no investigation recorded and fewer than 3% had a test for chlamydia.
  
  
  CONCLUSIONS
  These results indicate low rates of specific testing and treatment for sexually transmitted infections in males who attend general practice with symptoms of epididymo-orchitis. There is a need for further research to understand the pattern of care delivered in general practice.
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Mayfield House Room 322, University of Brighton, Falmer, Brighton BN1 9PH. a.c.nicholson@bsms.ac.uk
authors.forename: Amanda
authors.initials: A
authors.lastname: Nicholson
authors.forename: Greta
authors.initials: G
authors.lastname: Rait
authors.forename: Tarita
authors.initials: T
authors.lastname: Murray-Thomas
authors.forename: Gwenda
authors.initials: G
authors.lastname: Hughes
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Mercer
authors.forename: Jackie
authors.initials: J
authors.lastname: Cassell
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000453:epidemiology; D002692:Chlamydia trachomatis; D016208:Databases, Factual; D057286:Electronic Health Records; D004812:Epidemiologic Methods; D004823:Epididymitis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D005194:Family Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009920:Orchitis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents