Abstract

PIP: To determine whether the true incidence of gonorrheal urethritis in acute epididymitis is obscured by inadequate detection methods, all males admitted to the Urology Service of an American military hospital between February 1975-April 1977 with a diagnosis of epididymitis underwent 4 separate screening tests for concomitant gonorrheal urethritis. Assessment of the 4 screening methods showed that a culture of a calcium-alginate swab of the anterior urethra obtained prior to the 1st morning urination was positive in every case of gonorrhea detected, and was the most consistent means of detection. In the 2nd test, neither a gram stain smear nor the culture of the sperm sediment of a "urethral wash" proved reliable. Smears of the urethral wash yielded 36% false negatives while cultures yielded 54% false negatives. The Gram stain and culture of ejaculate were both reliable, but fewer than 1/2 of the patients with positive cultures were able or willing to provide a specimen. Among the positive cases, there was 1 false negative among the 5 ejaculates available for Gram stain, and all 5 ejaculates were positive on culture. The final method, Gram stain and culture of discharge, proved inadequate because a discharge was absent in 50% of the positive cases. Neither the patients' histories nor physical findings were diagnostic because of the overlap between positive and negative cases. 14 of the 88 consecutive patients admitted with acute epididymitis (16%) were found to have N. gonorrheae urethritis as well. The actual incidence may have been even higher since 31% of the patients were taking antibiotics prior to admission. The diagnosis of concomitant gonorrhea in acute epididymitis confirmed by culture offers the advantages of assuring adequate treatment of the patient and prompt treatment of the sex partners, preventing reinfection from untreated contacts, and assuring proper epidemiological reporting and appropriate serologic screening for concomitant syphilis.