Urologists often miss, mistreat Chlamydia

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Chlamydia trachomatis Image: © Mediscan/Corbis

Many urologists miss or misdiagnose Chlamydia in young, sexually active patients, according to a letter published online in the journal Sexually Transmitted Infections. Chlamydia trachomatis infection can lead to a condition known as epididymo-orchitis, in which the testicles and a tube that stores sperm become inflamed. These symptoms are similar to those of testicular tortion—a condition in which the testicle rotates, cutting off blood supply and creating painful swelling—prompting many men to seek the care of a urologist. Yet, in an analysis of five urology departments at teaching hospitals across the U.K. over a period of one and a half years, the authors noted that, of 204 men under age 35 diagnosed with epididymo-orchitis, few were actually tested for Chlamydia, and in only 10 cases did urologists correctly determine the source of the infection. What’s more, when patients were prescribed antibiotics to treat the condition, nearly half (44%) were given Ciprofloxacin, which Chlamydia may be resistant to, according to previous research. To make matters worse, in roughly one third of patients given the medication, the prescription was for less than the recommended two weeks.

The authors conclude that, based on this recent survey of urological centers, “urologists remain poor at managing epididymo-orchitis in sexually active young men, and are therefore almost certainly failing to diagnose many cases of chlamydia and other sexually transmitted infections in exactly the group both most at risk and most likely to have multiple partners.” This problem persists, the authors say, in spite of both clear clinical guidelines that have been in place for 10 years and informal educational programs. Based on these findings, they recommend that urology departments establish more rigorous protocol for the treatment of epididymo-orchitis, and detection of Chlamydia.

According to the authors, Chlamydia is the most commonly reported sexually transmitted infection in Europe. According to the Centers for Disease Control and Prevention, in the U.S. more than one million cases of Chlamydia are reported each year, representing only a fraction of the true number of infections. If left untreated, Chlamydia can lead to infertility.

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